NPIMap

Organization Active NPI

Cherrywood Advanced Living, LLC

Doing business as Cherrywood St Cloud 1030

  • Assisted Living Facility
  • Saint Cloud, MN
National Provider Identifier
1790128049
Registry record updated Apr 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
357491 Issued in MN
Legal business name
CHERRYWOOD ADVANCED LIVING, LLC
Doing business as
Cherrywood St Cloud 1030
Practice address
1030 Voyageur St
St Cloud, MN 56303
Phone
(320) 257-7445
Fax
(320) 257-7447
NPI assigned
Apr 16, 2013
Last updated
Apr 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2013

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

Authorized official

Name
Wendy Hulsebus
Title
Chief Operating Officer
Phone
(320) 257-7445

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 357491 MN Primary

Addresses

Primary practice location

1030 Voyageur St
St Cloud, MN 56303

Mailing address

1685 4TH Ave N
Sauk Rapids, MN 56379-2708
Phone (320) 257-7445

Other identifiers 1

IdentifierTypeStateIssuer
360196OtherMNHOUSING WITH SERVICES LICENSE

Other names 1

  • Cherrywood St Cloud 1030 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cherrywood Advanced Living LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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": "1366070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366070400000",
    "number": "1790128049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1685 4TH AVE N",
            "city": "SAUK RAPIDS",
            "state": "MN",
            "postal_code": "563792708",
            "telephone_number": "320-257-7445",
            "fax_number": "320-257-7447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 VOYAGEUR ST",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "56303",
            "telephone_number": "320-257-7445",
            "fax_number": "320-257-7447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHERRYWOOD ADVANCED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-16",
        "last_updated": "2013-04-16",
        "status": "A",
        "authorized_official_last_name": "HULSEBUS",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "320-257-7445"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "357491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOUSING WITH SERVICES LICENSE",
            "identifier": "360196",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cherrywood St Cloud 1030",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2013; 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.