Coventry Senior Living of Mahtomedi, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

355819 Issued in MN

Legal business name

COVENTRY SENIOR LIVING OF MAHTOMEDI, LLC

Doing business as

Coventry Assisted Living and Memory Care

Practice address

720 Mahtomedi Ave
Mahtomedi, MN 55115-1673

Phone

(651) 528-8442

Fax

(651) 756-8240

NPI assigned

Mar 6, 2012

Last updated

Mar 6, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

SENIOR PROPERTIES OF MAHTOMEDI, LLCAs reported in NPPES

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

Authorized official

Name

Carleigh Sawyer, LNHA

Title

Housing Manager

Phone

(651) 528-8442

Specialties & licenses 1

Addresses

Other names 1

• Coventry Assisted Living and Memory Care Doing business as

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

{
    "created_epoch": "1330992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330992000000",
    "number": "1962776187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 MAHTOMEDI AVE",
            "city": "MAHTOMEDI",
            "state": "MN",
            "postal_code": "551151673",
            "telephone_number": "651-528-8442",
            "fax_number": "651-756-8240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 MAHTOMEDI AVE",
            "city": "MAHTOMEDI",
            "state": "MN",
            "postal_code": "551151673",
            "telephone_number": "651-528-8442",
            "fax_number": "651-756-8240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENTRY SENIOR LIVING OF MAHTOMEDI, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SENIOR PROPERTIES OF MAHTOMEDI, LLC",
        "enumeration_date": "2012-03-06",
        "last_updated": "2012-03-06",
        "status": "A",
        "authorized_official_last_name": "SAWYER",
        "authorized_official_first_name": "CARLEIGH",
        "authorized_official_title_or_position": "HOUSING MANAGER",
        "authorized_official_telephone_number": "651-528-8442",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "355819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coventry Assisted Living and Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lisa Kerstin Channon I
• Audrey Marie Chaput, OTR/L
• City of Mahtomedi (Mahtomedi Fire Department)
• Richard Winfield Copeland Jr., DDS
• Core Chiropractic & Health
• Jessica Dresden, PSYD, LP
• Amanda Lynn Engen
• Caley Erban
• Jeannie Marie Farrell
• Olivia Fesser, MA, LMFT

• Home Health Agency in Mahtomedi, MN
• Providers in Mahtomedi, MN by specialty
• Home Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2012; 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.