Healthcare Provider Details

I. General information

NPI: 1366916900
Provider Name (Legal Business Name): THE EMERALDS AT GRAND RAPIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 S HIGHWAY 169
GRAND RAPIDS MN
55744-9552
US

IV. Provider business mailing address

8833 GROSS POINT RD STE 208
SKOKIE IL
60077-1859
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-3431
  • Fax:
Mailing address:
  • Phone: 507-203-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSH LEGUM
Title or Position: CEO
Credential:
Phone: 507-203-1001