Basic Information
| Provider Information | |||||||||
| NPI: | 1093050577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EARLE BROWN TERRACE OPERATIONS LLC | ||||||||
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| OtherOrganizationName: | EARLE BROWN TERRACE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 LOCUST ST STE 820 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503092334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5158754500 | ||||||||
| FaxNumber: | 5158754780 | ||||||||
| Practice Location | |||||||||
| Address1: | 6100 SUMMIT DR N | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN CENTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554302151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635606829 | ||||||||
| FaxNumber: | 7635033819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2012 | ||||||||
| LastUpdateDate: | 12/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | BUXO | ||||||||
| AuthorizedOfficialFirstName: | JUDI | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VP DIR OF ASSET MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 5158754500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.