Healthcare Provider Details

I. General information

NPI: 1598481442
Provider Name (Legal Business Name): BROOKVIEW COTTAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4359 BENT TREE LN
EAGAN MN
55123-3054
US

IV. Provider business mailing address

15140 DUPONT PATH
APPLE VALLEY MN
55124-5850
US

V. Phone/Fax

Practice location:
  • Phone: 651-340-6540
  • Fax: 952-777-2256
Mailing address:
  • Phone: 651-308-2528
  • Fax: 952-777-2256

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: MRS. TARA LAYNE TRUAX-NEWHOUSE
Title or Position: OWNER
Credential: RN
Phone: 651-308-2528