Healthcare Provider Details

I. General information

NPI: 1477930006
Provider Name (Legal Business Name): SENIOR CLASS CARE OF PEQUOT LAKES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8898 SCHALLER ROAD
PEQUOT LAKES MN
56472
US

IV. Provider business mailing address

8898 SCHALLER ROAD, PO BOX 410
PEQUOT LAKES MN
56472
US

V. Phone/Fax

Practice location:
  • Phone: 218-543-1035
  • Fax: 218-543-1035
Mailing address:
  • Phone: 218-232-1036
  • Fax: 218-543-1035

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 StateMN

VIII. Authorized Official

Name: PAMELA S FEHN
Title or Position: PRESIDENT
Credential:
Phone: 218-232-1036