Meadow Creek Developers, LLC

Primary specialty

Home Modifications ContractorTaxonomy code 171WH0202X

Legal business name

MEADOW CREEK DEVELOPERS, LLC

Practice address

218 Revere LN N
Champlin, MN 55316-1049

Phone

(612) 867-9581

NPI assigned

Jan 22, 2021

Organization subpart

No

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

Authorized official

Name

Peter J Lewis

Title

Owner

Phone

(612) 810-3881

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1611273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611273600000",
    "number": "1790375814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 REVERE LN N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553161049",
            "telephone_number": "612-867-9581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 REVERE LN N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553161049",
            "telephone_number": "612-867-9581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADOW CREEK DEVELOPERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-22",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-810-3881"
    },
    "taxonomies": [
        {
            "code": "171WH0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Contractor, Home Modifications",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUILDER",
            "identifier": "NONE",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "petelewislch@gmail.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "218 Revere Ln N",
            "city": "Champlin",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553161049",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Home Modifications Contractor in Champlin, MN
• Providers in Champlin, MN by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; 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.