Northland Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

335311 Issued in MN

Legal business name

NORTHLAND ASSISTED LIVING LLC

Doing business as

Northland Village

Practice address

22027 420TH Street
McGregor, MN 55760-5963

Phone

(218) 768-3356

Fax

(218) 768-3379

NPI assigned

Mar 8, 2007

Last updated

Oct 26, 2015By 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

Tony Sertich

Title

Chief Manager

Phone

(218) 723-4040

Specialties & licenses 1

Addresses

Other names 1

• Northland Village Doing business as

Locations

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445817600000",
    "number": "1710018122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 W SUPERIOR ST",
            "address_2": "SUITE 610",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558021936",
            "telephone_number": "218-723-4040",
            "fax_number": "218-723-4048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22027 420TH STREET",
            "city": "MCGREGOR",
            "state": "MN",
            "postal_code": "557605963",
            "telephone_number": "218-768-3356",
            "fax_number": "218-768-3379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAND ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2015-10-26",
        "status": "A",
        "authorized_official_last_name": "SERTICH",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "CHIEF MANAGER",
        "authorized_official_telephone_number": "218-723-4040"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "335311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northland Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in McGregor, MN
• Providers in McGregor, 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 Oct 26, 2015; 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.