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).
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 |
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 |
Street Address |
1187 BLACKHAWK DR SW |
City | HUTCHINSON |
State | MN |
Zip Code | 55350 |
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 |
Find all providers in zip 55350 |
Taxonomy Code | 320900000X |
Grouping | Residential Treatment Facilities |
Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
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] |
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 |
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 |
Find all providers with the same taxonomy |
City | HUTCHINSON |
Zip Code | 55350 |
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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.