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General NPI Number Information
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NPI Number | 1881689628
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Entity Type | Organization
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Legal Business Name | NORTH RIDGE SKILLED, LLC
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 5430 BOONE AVE N
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City | NEW HOPE
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State | MN
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Zip | 55428-3615
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Country | US
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Telephone | 763-492-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 5430 BOONE AVE N
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City | NEW HOPE
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State | MN
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Zip | 55428-3615
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Country | US
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Telephone | 763-592-2600
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Fax |
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Authorized Official
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Title or Position | DIRECTOR REVENUE CYCLE MANAGEMENT
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Name | BARNES MICHELLE
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Credential |
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Telephone | 813-895-1797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 327788
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License Number State | MN
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Legacy Identifiers
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Identifier #1
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Identifier Code | 531716900
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Identifier Type | MEDICAID
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Identifier State | MN
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Identifier Issuer |
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Identifier #2
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Identifier Code | 530698100
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Identifier Type | MEDICAID
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Identifier State | MN
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 530698100
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Identifier Type | MEDICAID
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Identifier State | MN
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Identifier Issuer |
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Identifier #2
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Identifier Code | 531716900
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Identifier Type | MEDICAID
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Identifier State | MN
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Identifier Issuer |
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