Serenity Living Solutions of Blackduck LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SERENITY LIVING SOLUTIONS OF BLACKDUCK LLC

Doing business as

Serenity Living Solutions of Blackduck

Practice address

441 4TH St NE
Blackduck, MN 56630-2167

Phone

(651) 374-1619

NPI assigned

Dec 12, 2024

Last updated

Dec 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Abdullahi Omar

Title

President

Phone

(651) 374-1619

Specialties & licenses 1

Addresses

Other names 1

• Serenity Living Solutions of Blackduck Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1733961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1649087768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2277 HIGHWAY 36 W STE 300",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133830",
            "telephone_number": "651-374-1619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "441 4TH ST NE",
            "city": "BLACKDUCK",
            "state": "MN",
            "postal_code": "566302167",
            "telephone_number": "651-374-1619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY LIVING SOLUTIONS OF BLACKDUCK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-12",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A",
        "authorized_official_last_name": "OMAR",
        "authorized_official_first_name": "ABDULLAHI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-374-1619",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Serenity Living Solutions of Blackduck",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Colleen Notsch
• Thomas K O'Reilly, D.C.
• Sanford Clinic North (Sanford Bemidji Blackduck Clinic)
• Sanford Health of Northern Minnesota (Sanford Blackduck Pharmacy)
• Sanford Health of Northern Minnesota (Sanford Blackduck Pharmacy)
• Tam of Blackduck PA (Moons Pharmacy)
• Tender Hearts
• The Evangelical Lutheran Good Samaritan Society (Good Samaritan Society - Blackduck)
• Heather Christine Tjepkes, DC
• Bree Villaran, PT

• Assisted Living Facility in Blackduck, MN
• Providers in Blackduck, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.