Basic Information
| Provider Information | |||||||||
| NPI: | 1104359827 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MINNESOTA SENIOR LIVING, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | THE RIVERS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11111 RIVER HILLS DR | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553373259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528908553 | ||||||||
| FaxNumber: | 9528909320 | ||||||||
| Practice Location | |||||||||
| Address1: | 11111 RIVER HILLS DR | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553373259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528908553 | ||||||||
| FaxNumber: | 9508909320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2017 | ||||||||
| LastUpdateDate: | 04/10/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ENSIGN | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | KRISTINE | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9528908553 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 380943 | MN | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 310400000X | 378575 | MN | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.