Willows Bend Senior Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

WILLOWS BEND SENIOR LIVING LLC

Practice address

6455 University Ave. NE
Fridley, MN 55432

Phone

(763) 308-2888

NPI assigned

Jul 12, 2022

Organization subpart

No

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

Authorized official

Name

Katelyn Mrozek, LALD

Title

Executive Director

Phone

(763) 308-2888

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

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

{
    "created_epoch": "1657584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657584000000",
    "number": "1780318279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6455 UNIVERSITY AVE. NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "55432",
            "telephone_number": "763-308-2888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6455 UNIVERSITY AVE. NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "55432",
            "telephone_number": "763-308-2888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWS BEND SENIOR LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-12",
        "last_updated": "2022-07-12",
        "certification_date": "2022-06-21",
        "status": "A",
        "authorized_official_last_name": "MROZEK",
        "authorized_official_first_name": "KATELYN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "763-308-2888",
        "authorized_official_credential": "LALD"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeff Williams
• Jennifer Leanne Williams, P.T.
• Nanette Williams, LMT, L.E.
• Sinah L Williams
• D'Undra Willis, LICSW
• Marion Wilson
• Phuong T Wippler, PHARMD
• Kristina L Withers, DPT
• William Allen Wittchow, PA-C
• Lorraine Woidylla, APRN, CNP

• Assisted Living Facility in Fridley, MN
• Providers in Fridley, 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 Jul 12, 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.