PHS Interlude Fridley LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PHS INTERLUDE FRIDLEY LLC

Practice address

520 Osborne Rd NE
Fridley, MN 55432-2718

Phone

(763) 230-3131

NPI assigned

Jul 16, 2014

Organization subpart

No

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

Authorized official

Name

Nicole Donahue

Title

Ceo/Administrator

Phone

(763) 230-3141

Specialties & licenses 1

Addresses

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Allina Health System

  • Radiation Oncology Clinic/Center
  • Coon Rapids, MN
  • NPI 1871478552

  Member Of

  NPD member
• Presbyterian Home Care Centers Inc

  • Skilled Nursing Facility
  • Roseville, MN
  • NPI 1679597322

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512086400000",
    "number": "1740697291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 OSBORNE RD NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322718",
            "telephone_number": "763-230-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 OSBORNE RD NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322718",
            "telephone_number": "763-230-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHS INTERLUDE FRIDLEY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-16",
        "last_updated": "2017-12-01",
        "status": "A",
        "authorized_official_last_name": "DONAHUE",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "763-230-3141"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn E Peterson, PT
• Reilly Peterson, DPT
• Kara Elizabeth Fay Pettigrew, MD
• Pharmacy Corporation of America
• Autumn Michelle Phenow, MSW, LICSW
• Richard Tad Pihlstrom, DDS
• James Piper, PA-C
• Ingrid Renee Podnieks, MD
• Christine Roberta Poe, CPNP
• Jennifer Pointon

• Skilled Nursing Facility in Fridley, MN
• Providers in Fridley, MN by specialty
• Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2017; 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.