MEDICARE: CENTER PARK SENIOR APARTMENTS, INC.

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	357410	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A438663000	OTHER	MN	UMPI

General Provider Information

NPI Number	:	1326464538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER PARK SENIOR APARTMENTS, INC.

Provider Business Mailing Address
First Line	:	5401 69TH AVE N
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1505
Country	:	US
Telephone Number	:	763-549-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 69TH AVE N
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1505
Country	:	US
Telephone Number	:	763-549-9600
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MARK MEYER
Credential	:
Telephone Number	:	651-631-6120

Provider Enumeration Date	:	03/12/2014
Last Update Date	:	03/12/2014

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