Basic Information
Provider Information
NPI: 1023241825
EntityType: 2
ReplacementNPI:  
OrganizationName: BROOKDALE SENIOR LIVING COMMUNITIES INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: STERLING HOUSE OF BLAINE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1005 PAUL PKWY NE
Address2:  
City: BLAINE
State: MN
PostalCode: 554343926
CountryCode: US
TelephoneNumber: 7637552800
FaxNumber: 7637556400
Practice Location
Address1: 1005 PAUL PKWY NE
Address2:  
City: BLAINE
State: MN
PostalCode: 554343926
CountryCode: US
TelephoneNumber: 7637552800
FaxNumber: 7637556400
Other Information
ProviderEnumerationDate: 08/26/2009
LastUpdateDate: 08/26/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: RIJOS
AuthorizedOfficialFirstName: JOHN
AuthorizedOfficialMiddleName: P
AuthorizedOfficialTitleorPosition: CO-PRESIDENT
AuthorizedOfficialTelephone: 3129773700
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: BROOKDALE SENIOR LIVING INC
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
310400000X MNY Nursing & Custodial Care FacilitiesAssisted Living Facility 

ID Information
IDTypeStateIssuerDescription
EW PROVIDER01MNMEDICAID WAIVEROTHER


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