Grace Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GRACE ASSISTED LIVING LLC

Practice address

2566 112TH Ave NW
Coon Rapids, MN 55433-3562

Phone

(612) 227-4036

NPI assigned

Nov 21, 2019

Organization subpart

No

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

Authorized official

Name

Kefyalew F Amante

Title

Owner

Phone

(612) 227-4036

Specialties & licenses 5

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": "1574294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581552000000",
    "number": "1952947269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2566 112TH AVE NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333562",
            "telephone_number": "612-227-4036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2566 112TH AVE NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333562",
            "telephone_number": "612-227-4036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-21",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A",
        "authorized_official_last_name": "AMANTE",
        "authorized_official_first_name": "KEFYALEW",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-227-4036"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabriel Daniel Gornet, DPT
• Trista M Gottwalt, MS, LADC
• Ronald P Gourneau, MD
• Richa Goyal, M.D.
• Kim Nicole Grabe, OT
• Joseph L Graif, M.D.
• Grand St Paul CVS LLC (CVS Pharmacy #16267)
• Grand St Paul CVS LLC (CVS Pharmacy #16508)
• Grand St Paul CVS LLC (CVS Pharmacy #01303)
• Kelley Graves, APRN

• Assisted Living Facility in Coon Rapids, MN
• Providers in Coon Rapids, 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 Feb 13, 2020; 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.