Healthcare Provider Details

I. General information

NPI: 1659795300
Provider Name (Legal Business Name): EAGLECREST SENIOR HOUSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 LINCOLN DR
ROSEVILLE MN
55113-1338
US

IV. Provider business mailing address

2845 HAMLINE AVE N
ROSEVILLE MN
55113-7127
US

V. Phone/Fax

Practice location:
  • Phone: 651-628-3000
  • Fax:
Mailing address:
  • Phone: 651-631-6432
  • Fax: 651-631-6122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number357428
License Number StateMN

VIII. Authorized Official

Name: JON TRANBY
Title or Position: AR DIRECTOR
Credential:
Phone: 651-631-6102