North Star Club, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

1066119 Issued in MN

Legal business name

NORTH STAR CLUB, LLC

Practice address

8040 Old Cedar Ave S
Bloomington, MN 55425-1234

Phone

(952) 542-6219

NPI assigned

Aug 26, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jason Fischer

Title

Manager

Phone

(952) 426-6219

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409011200000",
    "number": "1609276724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8040 OLD CEDAR AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8040 OLD CEDAR AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251234",
            "telephone_number": "952-542-6219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH STAR CLUB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-26",
        "last_updated": "2014-08-26",
        "status": "A",
        "authorized_official_last_name": "FISCHER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "952-426-6219"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MN",
            "license": "1066119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "1066119",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Adult Care Home Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.