Active NPI
Martin Luther Manor
- Skilled Nursing Facility
- Bloomington, MN
National Provider Identifier
1750301578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 331915
- Legal business name
- MARTIN LUTHER MANOR
- Practice address
- 1401 E 100TH St
Bloomington, MN 55425-2615 - Phone
- (952) 888-7751
- Fax
- (952) 888-5465
- NPI assigned
- Jul 21, 2006
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Dennis R Johnson
- Title
- Cfo
- Phone
- (651) 766-4300
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 331915 | MN | Primary |
Addresses
Primary practice location
1401 E 100TH St
Bloomington, MN 55425-2615
Mailing address
3530 Lexington Ave N
Saint Paul, MN 55126-8164
Phone (651) 766-4300
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8606MA | Other | MN | BLUE CROSS BLUE SHIELD |
| NH0033 | Other | MN | UCARE |
| 7122647 | Other | MEDICA | |
| 913423300 | Medicaid | MN |
National Provider Directory
National Provider Directory- Tax ID family
- Martin Luther Manor
Other organizations with this tax ID 42
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1750301578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3530 LEXINGTON AVE N",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551268164",
"telephone_number": "651-766-4300",
"fax_number": "651-766-4310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 E 100TH ST",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554252615",
"telephone_number": "952-888-7751",
"fax_number": "952-888-5465"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARTIN LUTHER MANOR",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-21",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "JOHNSON",
"authorized_official_first_name": "DENNIS",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "651-766-4300",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "MN",
"license": "331915",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "8606MA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "NH0033",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "7122647",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "913423300",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.