Nirvana North

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

NIRVANA NORTH

Practice address

503 Howard Gnesen Rd
Duluth, MN 55811-1614

Phone

(218) 343-7734

NPI assigned

Jun 18, 2024

Organization subpart

No

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

Authorized official

Name

Mr. Matthew Ryan Moore

Title

Owner

Phone

(218) 343-7734

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1718668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1992548739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 HOWARD GNESEN RD",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558111614",
            "telephone_number": "218-343-7734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 HOWARD GNESEN RD",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558111614",
            "telephone_number": "218-343-7734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIRVANA NORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-18",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-343-7734",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marika Nigrelli
• Daniel Alan Nikcevich
• Sheryl Lyn Nilsen, COTA
• Robert W Nipp, DPM
• Stacey Ann Nipp, DPM
• Andrew Sydney Nisbet, MD
• Ingrid Louisa Nisswandt-Larsen, MD
• Noble Dental PLLC
• Samuel Edward Noeldner
• Jessica Noelting, MD

• Mental Illness Community Based Residential Treatment Facility in Duluth, MN
• Providers in Duluth, MN by specialty
• Mental Illness Community Based Residential Treatment Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; 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.