THE HOMESTEAD AT COON RAPIDS INC. NPI 1578028585

NPI Information

NPI: 1578028585
Provider Name: THE HOMESTEAD AT COON RAPIDS, INC.
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 24D1029220

Address:
11372 ROBINSON DR NW
COON RAPIDS, MN
ZIP 55433
Phone: (763) 233-5100
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THE HOMESTEAD AT COON RAPIDS, INC. is an assisted living facility in Coon Rapids, MN. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. THE HOMESTEAD AT COON RAPIDS, INC. NPI is 1578028585. The provider is registered as an organization entity type.

The provider's business location address is:

11372 ROBINSON DR NW
COON RAPIDS, MN
ZIP 55433-071
Phone: (763) 233-5100

The provider's authorized official is Nancy Gavin .
The authorized official title is Assistant Secretary/assistant Treas and has the following contact phone number (952) 983-4249.

The CLIA number assigned to this NPI record is 24D1029220 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/4/2019 and was last updated on 2/5/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	PENDING	MEDICAID	MINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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