PHS/Cambridge Care Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

342879 Issued in MN

Legal business name

PHS/CAMBRIDGE CARE CENTER, LLC

Practice address

548 1St Ave W
Cambridge, MN 55008-1020

Phone

(763) 689-2323

NPI assigned

Nov 17, 2006

Reactivated

Mar 20, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Mark Meyer

Title

Cfo

Phone

(651) 631-6120

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• DBA: Grace Point Crossing - Gables East Former legal business name

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485216000000",
    "number": "1912071630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "548 1ST AVE W",
            "city": "CAMBRIDGE",
            "state": "MN",
            "postal_code": "550081020",
            "telephone_number": "763-231-0410",
            "fax_number": "763-231-0420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "548 1ST AVE W",
            "city": "CAMBRIDGE",
            "state": "MN",
            "postal_code": "550081020",
            "telephone_number": "763-689-2323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHS/CAMBRIDGE CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2017-01-24",
        "deactivation_date": "2007-01-29",
        "reactivation_date": "2007-03-20",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "651-631-6120",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "342879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "195487000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "NH0157",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA: Grace Point Crossing - Gables East",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Matthew J Peterson, DDS
• Samantha Peterson
• Stephanie Peterson, M.A.
• McKenzie Adeline Petschl
• Charles J Phillips, MD
• Melissa Pierson, DDS
• Sandra Pliam
• Mark A Pocrnich, D.D.S.
• Tia Portillo
• Elizabeth Laura Pouliot, OTD, OTR/L

• Skilled Nursing Facility in Cambridge, MN
• Providers in Cambridge, MN by specialty
• Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2017; 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.