NPIMap

Organization Active NPI

KTJ 270 LLC

  • Assisted Living Facility
  • Saint Paul, MN
National Provider Identifier
1619400199
Registry record updated Apr 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
32991 Issued in MN
Legal business name
KTJ 270 LLC
Practice address
4650 Centerville Rd
Saint Paul, MN 55127-2301
Phone
(651) 653-3288
NPI assigned
Apr 11, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2017

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

Authorized official

Name
Ms. Jackie Juan
Title
Executive Director
Phone
(651) 653-3288

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 32991 MN Primary

Addresses

Primary practice location

4650 Centerville Rd
Saint Paul, MN 55127-2301

Mailing address

4650 Centerville Rd
Saint Paul, MN 55127-2301
Phone (651) 653-3288

Other names 1

  • White Bear Heights Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1491868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491868800000",
    "number": "1619400199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 CENTERVILLE RD",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551272301",
            "telephone_number": "651-653-3288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 CENTERVILLE RD",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551272301",
            "telephone_number": "651-653-3288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KTJ 270 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-11",
        "last_updated": "2017-04-11",
        "status": "A",
        "authorized_official_last_name": "JUAN",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-653-3288",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "32991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Bear Heights",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2017; 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.