Park Place Senior Living, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PARK PLACE SENIOR LIVING, LLC

Practice address

125 E Park St
Owatonna, MN 55060-4067

Phone

(507) 451-0808

NPI assigned

Nov 9, 2017

Organization subpart

No

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

Authorized official

Name

Dave Vandergon

Title

Ceo/Administrator

Phone

(612) 961-9672

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1510185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510185600000",
    "number": "1942713102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1995 E RUM RIVER DR S",
            "city": "CAMBRIDGE",
            "state": "MN",
            "postal_code": "550082656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 E PARK ST",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550604067",
            "telephone_number": "507-451-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK PLACE SENIOR LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-09",
        "last_updated": "2017-11-09",
        "status": "A",
        "authorized_official_last_name": "VANDERGON",
        "authorized_official_first_name": "DAVE",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "612-961-9672"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.