Healthcare Provider Details

I. General information

NPI: 1285010074
Provider Name (Legal Business Name): EAGAN POINTE SENIOR LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4232 BLACK HAWK ROAD
EAGAN MN
55122
US

IV. Provider business mailing address

945 SIBLEY MEMORIAL HIGHWAY
LILYDALE MN
55118
US

V. Phone/Fax

Practice location:
  • Phone: 651-492-6535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KELLY J MYERS
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 651-492-6535