Healthcare Provider Details

I. General information

NPI: 1659856417
Provider Name (Legal Business Name): STONEHAVEN SENIOR HOUSING OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 STATION TRL
EAGAN MN
55123-1358
US

IV. Provider business mailing address

1000 STATION TRL
EAGAN MN
55123-1358
US

V. Phone/Fax

Practice location:
  • Phone: 651-686-4366
  • Fax:
Mailing address:
  • Phone: 651-686-4366
  • 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: DANIELLE CROSSLEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 651-686-4366