AUGUSTANA SENIOR DEVELOPMENT II — NPI 1154639128 (Licensed & Credentialed Assisted Living Facility in MORA, MN)

CMS-1500 Box 24J / 33a • NPI

1154639128

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

310400000X

Licensed & Credentialed Assisted Living Facility

Box 32 Service Location & ZIP+4

170 VALHALLA CIRCLE, MORA, MN, 55051

Official NPPES Practice Location

Practice Phone & Referral Fax

(320) 679-4789

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1154639128 (AUGUSTANA SENIOR DEVELOPMENT II) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1154639128` (NPI-2 Organization / Facility)
Provider / Legal Name	AUGUSTANA SENIOR DEVELOPMENT II
Plain-English Specialty	Licensed & Credentialed Assisted Living Facility NUCC Code: `310400000X` (Assisted Living Facility)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	170 VALHALLA CIRCLE, MORA, MN, 55051
Practice Telephone / Fax	Tel: (320) 679-4789
Administrative Mailing Address	170 VALHALLA CIRCLE, MORA, MN, 55051
Enumeration & Last Sync	Enumerated: 2010-09-23 \| CMS Record Updated: 2018-04-02
Authorized Official	CRAIG KITTELSON (Chief Financial Officer)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

170 VALHALLA CIRCLE, MORA, MN, 55051

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Plain-English Taxonomy & CMS Crosswalk (310400000X)

What Does Taxonomy Code 310400000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 310400000X translates to:
"Licensed & Credentialed Assisted Living Facility"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Assisted Living Facility for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (AUGUSTANA SENIOR DEVELOPMENT II)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`310400000X` — Assisted Living Facility Plain English: Licensed & Credentialed Assisted Living Facility	State: MN \| License: `349304` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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AUGUSTANA SENIOR DEVELOPMENT II (NPI #1154639128)