AUTUMN GLEN SENIOR LIVING
NPI 1104323773
Assisted Living Facility in Coon Rapids, MN
NPI Status: Active since April 10, 2018
Contact Information
3715 COON RAPIDS BLVD NW
COON RAPIDS, MN
ZIP 55433
Phone: (763) 772-4492
- Organization
- Assisted Living Facility
- CLIA Number: 24D2148947
- CLIA Cert. Type: Assisted Living Facility
- CLIA Exp. Date: 05-21-2028
About AUTUMN GLEN SENIOR LIVING
This page provides the complete NPI Profile along with additional information for Autumn Glen Senior Living, a provider established in Coon Rapids, Minnesota operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1104323773 assigned on April 2018. The practitioner's primary taxonomy code is 310400000X with license number 381474 (MN). The provider is registered as an organization and their NPI record was last updated 8 years ago. The provider's is doing business as Autumn Glen Senior Living. The authorized official of this NPI record is James A Weichert (Director Of General Partner)
- NPI
- 1104323773
- Provider Legal Name
- NEW WESTERN MANOR COMPANY LIMITED PARTNERSHIP
- Other Organization Name
- AUTUMN GLEN SENIOR LIVING
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 3715 COON RAPIDS BLVD NW COON RAPIDS, MN 55433
- Location Phone
- (763) 772-4492
- Mailing Address
- 1107 HAZELTINE BLVD STE 200 CHASKA, MN 55318
- Mailing Phone
- (612) 618-1682
- Mailing Fax
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-10-2018
- Last Update Date
- 06-19-2018
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Assisted Living Facility
- Taxonomy Code
- 310400000X
- Type
- Nursing & Custodial Care Facilities
- License No.
- 381474
- License State
- MN
- Taxonomy Description
- 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.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 24D2148947
- Facility Type
- Assisted Living Facility
- Certificate Effective Date
- May 22, 2026
- Certificate Expiration Date
- May 21, 2028
- Laboratory Director
- MELANIE IDZIOREK
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Autumn Glen Senior Living to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1104323773, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 57. The final step is to find the difference between that total and the next multiple of ten (60 - 57 = 3).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 57 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
COON RAPIDS, MN 55433
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104323773, enumerated as an "organization" on April 10, 2018.
The provider is located at 3715 COON RAPIDS BLVD NW COON RAPIDS, MN 55433 and the phone number is (763) 772-4492.
Assisted Living Facility with taxonomy code 310400000X.
