Healthcare Provider Details

I. General information

NPI: 1134773047
Provider Name (Legal Business Name): STONECREST LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 MERRIAM RD
MINNETONKA MN
55305-5049
US

IV. Provider business mailing address

4108 MERRIAM RD
MINNETONKA MN
55305-5049
US

V. Phone/Fax

Practice location:
  • Phone: 612-422-1251
  • Fax: 612-392-7928
Mailing address:
  • Phone: 612-422-1251
  • Fax: 612-392-7928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: STONECREST LIVING
Title or Position: ADMIN
Credential:
Phone: 612-422-1251