=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558235234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIVIE SENIOR LIVING OF NORTHFIELD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2025
-----------------------------------------------------
Last Update Date | 10/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 910 CANNON VALLEY DR
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55057-3300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-645-6007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2209 JEFFERSON ST STE 201
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56308-2848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-763-1164
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MARNIE MARIE GUGISBERG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 320-763-1164
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------