Jennier Renee Johnson, PRESIDENT

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

354457 Issued in MN

Practice address

8783 2ND Street South
Brookston, MN 55711-0367

Phone

(218) 453-5062

Fax

(218) 453-5064

NPI assigned

Oct 26, 2011

Last updated

Oct 26, 2011By 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 3

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.

• Stonehaven Assisted Living Inc.

  • Assisted Living Facility
  • Brookston, MN
  • NPI 1790060838
  NPD (past)

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

{
    "created_epoch": "1319587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319587200000",
    "number": "1942586532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BOX 367",
            "address_2": "8783 2ND STREET S",
            "city": "BROOKSTON",
            "state": "MN",
            "postal_code": "557110367",
            "telephone_number": "218-453-5062",
            "fax_number": "218-453-5064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8783 2ND STREET SOUTH",
            "city": "BROOKSTON",
            "state": "MN",
            "postal_code": "557110367",
            "telephone_number": "218-453-5062",
            "fax_number": "218-453-5064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JENNIER",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "PRESIDENT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-26",
        "last_updated": "2011-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "354457",
            "primary": true
        },
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "MN",
            "license": "FBL-26096-34148",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MN",
            "license": "354448",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ajbb Duluth Properties (Anderson's Pine Grove)
• Brooke Manor Inc
• Abby Johnsen, NBCHWC
• Peterson Colonial Homes, Inc.
• Sharon Shofner Adult Foster Care
• Andrew Timothy Shofner
• Stonehaven Assisted Living Inc.
• Transitions Plus, Inc.

• Assisted Living Facility in Brookston, MN
• Providers in Brookston, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2011; 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.