Healthcare Provider Details

I. General information

NPI: 1366769598
Provider Name (Legal Business Name): AUGUSTANA DASSEL LAKESIDE COMMUNITY HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 WILLIAM AVE E
DASSEL MN
55325-1103
US

IV. Provider business mailing address

441 WILLIAM AVE E
DASSEL MN
55325-1103
US

V. Phone/Fax

Practice location:
  • Phone: 320-275-3308
  • Fax:
Mailing address:
  • Phone: 320-275-3308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateMN

VIII. Authorized Official

Name: SEELOCHANI STADTHERR
Title or Position: ASSOCIATE VP OF REVENUE CYCLE MGMT
Credential:
Phone: 952-855-5041