Healthcare Provider Details

I. General information

NPI: 1548667694
Provider Name (Legal Business Name): FCSL GRAND RAPIDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 SW 11TH AVE
GRAND RAPIDS MN
55744-3562
US

IV. Provider business mailing address

2701 W SUPERIOR ST SUITE 101
DULUTH MN
55806-1856
US

V. Phone/Fax

Practice location:
  • Phone: 218-327-9463
  • Fax:
Mailing address:
  • Phone: 218-625-8488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number370701
License Number StateMN

VIII. Authorized Official

Name: NATALIE ZELEZNIKAR
Title or Position: OWNER
Credential:
Phone: 218-625-8488