Healthcare Provider Details

I. General information

NPI: 1558652909
Provider Name (Legal Business Name): CHERRYWOOD ADVANCED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BARRY AVE NW
RICHMOND MN
56368-4560
US

IV. Provider business mailing address

1685 4TH AVE N
SAUK RAPIDS MN
56379-2708
US

V. Phone/Fax

Practice location:
  • Phone: 320-597-6150
  • Fax: 320-597-6151
Mailing address:
  • Phone: 320-257-7445
  • Fax: 320-257-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number348548
License Number StateMN

VIII. Authorized Official

Name: WENDY HULSEBUS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 320-257-7445