Healthcare Provider Details

I. General information

NPI: 1669921912
Provider Name (Legal Business Name): EDINA SENIOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 FRANCE AVE S
EDINA MN
55435-1703
US

IV. Provider business mailing address

6500 FRANCE AVE S
EDINA MN
55435-1703
US

V. Phone/Fax

Practice location:
  • Phone: 952-848-8888
  • Fax:
Mailing address:
  • Phone: 952-848-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateMN

VIII. Authorized Official

Name: MR. MARK THOMAS
Title or Position: CEO
Credential:
Phone: 612-874-3460