MEDICARE: VSR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	9908	MT

General Provider Information

NPI Number	:	1245268671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VSR LLC

Provider Business Mailing Address
First Line	:	1107 HAZELTINE BLVD
Second Line	:	SUITE 200
City	:	CHASKA
State	:	MN
Zip	:	55318-1009
Country	:	US
Telephone Number	:	952-361-8000
Fax Number	:	952-361-8060

Provider Business Practice Location Address
First Line	:	2815 OLD FORT RD
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-7422
Country	:	US
Telephone Number	:	406-549-1300
Fax Number	:	406-721-1620

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN B GOODMAN
Credential	:
Telephone Number	:	952-361-8000

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	05/30/2014

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