Select Senior Living of Coon Rapids, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

339176 Issued in MN

Legal business name

SELECT SENIOR LIVING OF COON RAPIDS, LLC

Practice address

11350 Martin St NW
Coon Rapids, MN 55433-3988

Phone

(763) 767-1127

Fax

(651) 455-0267

NPI assigned

Apr 18, 2008

Last updated

Apr 18, 2008By 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

Kelly J Myers

Title

Residence Director

Phone

(651) 492-6535

Specialties & licenses 1

Addresses

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": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208476800000",
    "number": "1720252836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11350 MARTIN ST NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333988",
            "telephone_number": "763-767-1127",
            "fax_number": "651-455-0267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11350 MARTIN ST NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333988",
            "telephone_number": "763-767-1127",
            "fax_number": "651-455-0267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELECT SENIOR LIVING OF COON RAPIDS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-18",
        "last_updated": "2008-04-18",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "RESIDENCE DIRECTOR",
        "authorized_official_telephone_number": "651-492-6535"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "339176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Sebo, CNP
• Secured Health and Home Assisted Living LLC (Secured Health Assisted Living)
• Melissa Mary Sedey, CNP
• Eli Sedo
• Jessica Lynn Seiler, LADC/ LPCC CANDIDATE
• Sere Path Wellness Center LLC
• Adam Setten, ATC
• Mark Daniel Severt, DDS
• Jessica Sewalson, PHARMD
• Marjorie Jean Sexton, MD

• Assisted Living Facility in Coon Rapids, MN
• Providers in Coon 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 Apr 18, 2008; 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.