Cornerstone Residence of Bagley, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

CORNERSTONE RESIDENCE OF BAGLEY, INC

Practice address

30 Sunset Ave SW
Bagley, MN 56621

Phone

(218) 694-2701

Fax

(218) 694-2718

NPI assigned

Jun 4, 2009

Organization subpart

No

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

Authorized official

Name

Allen Potvin

Title

Owner/President

Phone

(218) 435-6205

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1244073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244073600000",
    "number": "1942436985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 SUNSET AVE SW",
            "city": "BAGLEY",
            "state": "MN",
            "postal_code": "56621",
            "telephone_number": "218-694-2701",
            "fax_number": "218-694-2718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 SUNSET AVE SW",
            "city": "BAGLEY",
            "state": "MN",
            "postal_code": "56621",
            "telephone_number": "218-694-2701",
            "fax_number": "218-694-2718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE RESIDENCE OF BAGLEY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-04",
        "last_updated": "2009-06-04",
        "status": "A",
        "authorized_official_last_name": "POTVIN",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "218-435-6205"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clearwater County Department of Human Services
• Clearwater County Memorial Hospital
• Clearwater County Memorial Hospital
• Clearwater Health Services
• Cornerstone Nursing and Rehab Center, Inc
• Cornerstone Senior Living, LLC
• County of Clearwater
• Kirsten Ruth Craft, MA, LPCC
• Kimberly Kae Crist, LPN
• Cassandra Lea Dahl

• All providers in Bagley, MN
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.