Crystal Larson

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

414944 Issued in MN

Practice address

11204 86TH Ave N
Maple Grove, MN 55369-4510

Phone

(612) 470-0105

Fax

(612) 299-1425

NPI assigned

Mar 22, 2024

Last updated

Mar 22, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gogo Home Care LLC

  dba Amada Senior Care Minneapolis-St. Paul

  • In Home Supportive Care Agency
  • Maple Grove, MN
  • NPI 1558277574
  NPD (past) Authorized official

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

{
    "created_epoch": "1711065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1861252082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14111 93RD PL N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553698912",
            "telephone_number": "612-670-2058",
            "fax_number": "612-299-1425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11204 86TH AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694510",
            "telephone_number": "612-470-0105",
            "fax_number": "612-299-1425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "CRYSTAL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-22",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "MN",
            "license": "414944",
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "MN",
            "license": "414944",
            "primary": false
        },
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "MN",
            "license": "414944",
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": "414944",
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "414944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roxie Lou Lange, RN
• Vanessa Lange, PA-C
• Janis Langsdale
• Beth A Larson, LP (PSYCHOLOGIST)
• Brandon Bruce Larson, OD
• David Larson, LADC
• Jeannie Therese Larson, MD
• Lindsey Brooke Larson
• Tailor Larson
• Samuel Larum, PHARMD

• Home Health Agency in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Home Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; 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.