Healthcare Provider Details

I. General information

NPI: 1982085221
Provider Name (Legal Business Name): SAINT THERESE COLLABORATIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 OAKDALE AVE N 4TH FLOOR
ROBBINSDALE MN
55422-2926
US

IV. Provider business mailing address

1660 HIGHWAY 100 S STE 103
ST LOUIS PARK MN
55416-1529
US

V. Phone/Fax

Practice location:
  • Phone: 952-983-2203
  • Fax: 952-224-0991
Mailing address:
  • Phone: 952-283-2203
  • Fax: 952-224-0991

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: CAL M SHELANGOSKI
Title or Position: CFO
Credential:
Phone: 952-283-2204