Healthcare Provider Details

I. General information

NPI: 1255683660
Provider Name (Legal Business Name): AJBB DULUTH PROPERTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 HWY. 31
BROOKSTON MN
55711
US

IV. Provider business mailing address

633 MAPLE ST
CLOQUET MN
55720-1449
US

V. Phone/Fax

Practice location:
  • Phone: 218-453-5554
  • Fax: 218-453-1014
Mailing address:
  • Phone: 218-453-5554
  • Fax: 218-453-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER MICHAEL BEAUCHAMP
Title or Position: OWNER/MANAGER
Credential:
Phone: 218-453-5554