ACTIVELY LIVING LIFE INC


Address: 1187 Blackhawk Dr Sw, Hutchinson, MN 55350
Phone: 9522154616

ACTIVELY LIVING LIFE INC (NPI# 1023455243) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1023455243
Entity Type Organization
Organization Name ACTIVELY LIVING LIFE INC
Practice Address 1187 Blackhawk Dr Sw
Hutchinson
MN 55350
Practice Telephone 9522154616
Practice Fax Number 9529747851
Mailing Telephone 9522154616
Enumeration Date 2013-05-29
Last Update Date 2018-07-06
Authorized Official Name LUKE LAIDLAW (PRESIDENT)
Authorized Official Telephone 3202952460
Authorized Official Credential OWNER/DIRECTOR
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 320900000X Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities MN Residential Treatment Facilities

Office Location

Street Address 1187 BLACKHAWK DR SW
City HUTCHINSON
State MN
Zip Code 55350

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1063971521 Carrie Morgando Counselor 255 Minnesota 7, Hutchinson, MN 55350 2019-03-14
1790243046 Thrifty Drug Stores Inc Durable Medical Equipment & Medical Supplies 1460 Montreal St, Hutchinson, MN 55350 2019-03-06
1376013953 Complete Assessments LLC Rehabilitation, Substance Use Disorder Unit 340 5th Ave Sw, Hutchinson, MN 55350 2018-11-27
1891283743 Abby Ann Trettin Optometrist 1059 Mn-15, Hutchinson, MN 55350 2018-04-26
1154862142 Serena Roehl Specialist/Technologist 150 Orchard Ave Se, Hutchinson, MN 55350 2017-03-10
1093264616 Jessica Munsch Occupational Therapist 544 Prospect St. Ne, Hutchinson, MN 55350 2016-09-23
1962835777 Jacqui Marie Ruzicka Counselor 255 Highway 7 E, Hutchinson, MN 55350 2013-08-15
1669711966 Stacy Marie Vancura Counselor 902 Highway 15 S Ste 200, Hutchinson, MN 55350 2013-02-06
1619226040 Samantha Heather Stevens Registered Nurse 246 S. Main St., Prairie River Home Care, Hutchinson, MN 55350 2012-08-30
1245585918 Trisha Anne Negen Licensed Practical Nurse 246 S Main St., Prairie River Homecare, Hutchinson, MN 55350 2012-07-19
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Taxonomy Information

Taxonomy Code 320900000X
Grouping Residential Treatment Facilities
Classification Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities

Taxonomy Definition

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.
Notes: [7/1/2003: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1396173183 Aspie Life Adventure LLC Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 912 W 18th Ave, Hutchinson, KS 67502-4140 2013-10-15

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1184244527 Kam Homecare Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 1500 Nicollet Ave Apt 305, Minneapolis, MN 55403-2724 2020-04-24
1477117885 Kelly Rae Martin Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 13881 Schuelke Beach Rd Nw, Miltona, MN 56354 2019-05-01
1295291573 Tricia Bastian Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 607 4th St S, Walker, MN 56484-6400 2019-02-12
1881163632 Jacob Wrich Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 603 3rd St W Apt 1, Hastings, MN 55033-1127 2018-11-21
1003394479 Malissa Ann Costanzo Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 844 8th Ave Se, Forest Lake, MN 55025 2018-07-30
1154814564 Laurie K. Tazelaar-williams Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 5253 W Bald Eagle Blvd, White Bear Lake, MN 55110-6532 2018-06-11
1205340577 Dale Conrad Forslin Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 1029 Highway 65 Ste 107, Braham, MN 55006-3360 2017-11-25
1952831026 Noble Senior Center Inc Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 1094 University Ave W, Saint Paul, MN 55104 2017-06-12
1407396336 Viko Health Services Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 5651 69th Ave N, 203, Brooklyn Park, MN 55429-1579 2017-02-25
1972052702 Marie-noel Hiol-hiol Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 14642 Quartz Ter Nw, Ramsey, MN 55303-4581 2016-09-21
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Competitor

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City HUTCHINSON
Zip Code 55350

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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