Blaine Care Group LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

Legal business name

BLAINE CARE GROUP LLC

Doing business as

Edgemont Place Alzheimer's Special Care Center

Practice address

11748 Ulysses Lane NE
Blaine, MN 55434

Phone

(763) 862-7000

Fax

(763) 862-7001

NPI assigned

Nov 16, 2020

Last updated

Jun 3, 2021By 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. W. Cody Erwin

Title

Managing Member

Phone

(360) 772-1645

Specialties & licenses 1

Addresses

Other names 1

• Edgemont Place Alzheimer's Special Care Center Doing business as

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1605484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622678400000",
    "number": "1699377440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 NE 82ND AVE STE 200",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626343",
            "telephone_number": "360-254-9442",
            "fax_number": "360-254-1770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11748 ULYSSES LANE NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "55434",
            "telephone_number": "763-862-7000",
            "fax_number": "763-862-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAINE CARE GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-16",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A",
        "authorized_official_last_name": "ERWIN",
        "authorized_official_first_name": "W.",
        "authorized_official_middle_name": "CODY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "360-772-1645",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Blaine",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11748 Ulysses Lane NE",
            "city": "Blaine",
            "state": "MN",
            "country_code": "US",
            "postal_code": "55434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Edgemont Place Alzheimer's Special Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Noah D Biro
• Andrea Bistodeau, PHARMD
• Duane Cleabert Bjerke, MA, LMFT
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• Alzheimer Center (Dementia Center) in Blaine, MN
• Providers in Blaine, MN by specialty
• Alzheimer Center (Dementia Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2021; 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.