Mystic Meadow Homes, Inc

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

MYSTIC MEADOW HOMES, INC

Practice address

40439 348TH LN
Aitkin, MN 56431-5672

Phone

(218) 821-3419

NPI assigned

Aug 2, 2007

Organization subpart

No

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

Authorized official

Name

Cassandra L Litke

Title

Administrator

Phone

(218) 821-3419

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1186012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186012800000",
    "number": "1861683138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16120 COUNTY ROAD 22",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564011844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40439 348TH LN",
            "city": "AITKIN",
            "state": "MN",
            "postal_code": "564315672",
            "telephone_number": "218-821-3419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC MEADOW HOMES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-02",
        "last_updated": "2007-08-02",
        "status": "A",
        "authorized_official_last_name": "LITKE",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "218-821-3419"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmentally Disabled Services Day Training Agency in Aitkin, MN
• Providers in Aitkin, MN by specialty
• Developmentally Disabled Services Day Training Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2007; 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.