OrganizationActive
Ktj 212, LLC
NPI 1104480714 · Assisted Living Facility · Excelsior, MN
Ktj 212, LLC is a Assisted Living Facility organization in Excelsior, MN (NPI 1104480714).
Provider details
- NPI number
- 1104480714
- Entity type
- Organization
- Primary specialty
- Assisted Living FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Lisa Miskulin, Executive Director(952) 401-7444
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Established profile(66/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
6000 Chaska Rd
Excelsior, MN 55331-3173
Phone: (952) 401-7444
Street-level locationGet directions
Mailing address
6000 Chaska Rd
Excelsior, MN 55331-3173
Other names (DBA / former)
- Doing business as
- Shorewood Landing Senior Living
Registry dates
- Enumerated
- 2019-04-29
- Last updated
- 2019-04-29
Frequently asked questions
- What is Ktj 212, LLC's NPI number?
- Ktj 212, LLC's National Provider Identifier (NPI) is 1104480714, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Ktj 212, LLC?
- Ktj 212, LLC is classified in the NPPES registry as Assisted Living Facility (Nursing & Custodial Care Facilities).
- Where is Ktj 212, LLC located?
- Ktj 212, LLC's practice location on file with NPPES is 6000 Chaska Rd, Excelsior, MN 55331-3173.
- What is Ktj 212, LLC's phone number?
- The practice phone number listed in the NPPES registry for Ktj 212, LLC is (952) 401-7444.
- Who is the authorized official for Ktj 212, LLC?
- The authorized official listed on Ktj 212, LLC's NPPES record is Lisa Miskulin, Executive Director. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Ktj 212, LLC's NPI active?
- Yes — Ktj 212, LLC's NPI (1104480714) is active in the NPPES registry as of the last update on 2019-04-29.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.