Ki Senior Living of Park Rapids, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

KI SENIOR LIVING OF PARK RAPIDS, LLC

Doing business as

Crystal Brook Senior Living

Practice address

1006 Crocus Hill St E
Park Rapids, MN 56470-5419

Phone

(218) 699-3605

NPI assigned

Jun 22, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Marnie Marie Gugisberg

Title

Cfo

Phone

(320) 763-1164

Specialties & licenses 1

Addresses

Other names 1

• CRYSTAL BROOK SENIOR LIVING 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

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

{
    "created_epoch": "1529625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529625600000",
    "number": "1659866630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 12TH AVE E",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563082612",
            "telephone_number": "320-763-6653",
            "fax_number": "320-763-7548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 CROCUS HILL ST E",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564705419",
            "telephone_number": "218-699-3605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KI SENIOR LIVING OF PARK RAPIDS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-22",
        "last_updated": "2018-06-22",
        "status": "A",
        "authorized_official_last_name": "GUGISBERG",
        "authorized_official_first_name": "MARNIE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "320-763-1164",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRYSTAL BROOK SENIOR LIVING",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer M Keller, O.D.
• Jade Kelley, PHARMD, RPH
• Mariah Rose Kemmer
• Laura Kempnich, MSW, LGSW
• Genevieve A Keranen, CDE
• Jessica J Kimball
• Brianna Kirchner, MA, LPCC
• Joel T.G. Kirchner, PHD
• Laura Lynn Kirlin, LICSW
• Paula Jane Kitzmann, LICSW

• Assisted Living Facility in Park Rapids, MN
• Providers in Park Rapids, 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 Jun 22, 2018; 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.