Healthcare Provider Details

I. General information

NPI: 1619291721
Provider Name (Legal Business Name): EAGLE'S CROSSING ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SPRUCE ST
GREY EAGLE MN
56336
US

IV. Provider business mailing address

103 SPRUCE ST
GREY EAGLE MN
56336
US

V. Phone/Fax

Practice location:
  • Phone: 320-285-3128
  • Fax: 320-285-3128
Mailing address:
  • Phone: 320-285-3128
  • Fax: 320-285-3128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1053344
License Number StateMN

VIII. Authorized Official

Name: MRS. DIANE KAY KRAMER
Title or Position: OWNER/ADULT DAY CENTER DIRECTOR
Credential:
Phone: 320-285-3128