GPH Bemidji, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GPH BEMIDJI, INC

Doing business as

Goldpine Home

Practice address

1700 30TH St NW
Bemidji, MN 56601-5608

Phone

(218) 444-4346

Fax

(218) 444-4083

NPI assigned

Oct 3, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Judy Marie Killian, R.N.

Title

Owner

Phone

(218) 444-4346

Specialties & licenses 1

Addresses

Other names 1

• GOLDPINE HOME Doing business as

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972698561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 30TH ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015608",
            "telephone_number": "218-444-4346",
            "fax_number": "218-444-4083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 30TH ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015608",
            "telephone_number": "218-444-4346",
            "fax_number": "218-444-4083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GPH BEMIDJI, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KILLIAN",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-444-4346",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GOLDPINE HOME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexandra Beatriz Gonzalez Juarrero
• Tiara Rae Goodwin, RN
• Melody Lynn Gorden, MSW LICSW
• Abigayle Gorski
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• Joshua Herold Vernon Granly, REGISTERED NURSE

• Assisted Living Facility in Bemidji, MN
• Providers in Bemidji, 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 Aug 22, 2020; 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.