Gaylord Lakeview Home

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

318160 Issued in MN

Legal business name

GAYLORD LAKEVIEW HOME

Practice address

640 3Rd St
Gaylord, MN 55334-2297

Phone

(507) 237-2911

Fax

(507) 237-5744

NPI assigned

Jun 28, 2005

Organization subpart

No

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

Authorized official

Name

Mary Nell Zellner

Title

Administrator

Phone

(507) 237-2911

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184544000000",
    "number": "1750388336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 3RD ST",
            "city": "GAYLORD",
            "state": "MN",
            "postal_code": "553342297",
            "telephone_number": "507-237-2911",
            "fax_number": "507-237-5744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 3RD ST",
            "city": "GAYLORD",
            "state": "MN",
            "postal_code": "553342297",
            "telephone_number": "507-237-2911",
            "fax_number": "507-237-5744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAYLORD LAKEVIEW HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-28",
        "last_updated": "2007-07-16",
        "status": "A",
        "authorized_official_last_name": "ZELLNER",
        "authorized_official_first_name": "MARY NELL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "507-237-2911"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "318160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "9711LA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "71-22555",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• First Choice Pharmacy Inc (First Choice Pharmacy)
• First Choice Pharmacy of Gaylord MN, PLLC
• Emma Jo Fowler, D.C.
• Josh Daniel Gavin, PTA
• Gaylord Dental Inc
• Jill Elizabeth Hewitt, M.S., L.M.F.T
• Angela Rose Hoff, MA OTR/L
• Renee Lynn Kleindl, COTA/L
• Klara Koch, OTR
• Jenna M Krautkremer, PTA

• Skilled Nursing Facility in Gaylord, MN
• Providers in Gaylord, 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 Jul 16, 2007; 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.