NPIMap

Organization Active NPI

Community Asset Foundation, LLC

Doing business as The Lodge of Mountain Lake

  • Assisted Living Facility
  • Mountain Lake, MN
National Provider Identifier
1750622908
Registry record updated Apr 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
29275 Issued in MN
Legal business name
COMMUNITY ASSET FOUNDATION, LLC
Doing business as
The Lodge of Mountain Lake
Practice address
603 7TH Ave
Mountain Lake, MN 56159-1333
Phone
(507) 427-2465
NPI assigned
Mar 13, 2013
Last updated
Apr 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2022

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

Authorized official

Name
David C Pokorney
Title
Treasurer
Phone
(612) 703-5709

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 29275 MN Primary

Addresses

Primary practice location

603 7TH Ave
Mountain Lake, MN 56159-1333

Mailing address

745 Basinger Memorial Dr
Mountain Lake, MN 56159-1312

Other names 1

  • The Lodge of Mountain Lake Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D1016198The Lodge of Mountain Lake603 7TH Avenue, Mountain Lake, MN 56159Certificate of waiverAug 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Asset Foundation LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1363132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649808000000",
    "number": "1750622908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 BASINGER MEMORIAL DR",
            "city": "MOUNTAIN LAKE",
            "state": "MN",
            "postal_code": "561591312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 7TH AVE",
            "city": "MOUNTAIN LAKE",
            "state": "MN",
            "postal_code": "561591333",
            "telephone_number": "507-427-2465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY ASSET FOUNDATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-13",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A",
        "authorized_official_last_name": "POKORNEY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "612-703-5709"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "29275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Lodge of Mountain Lake",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Lodge of Mountain Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; 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.