Healthcare Provider Details

I. General information

NPI: 1639689409
Provider Name (Legal Business Name): CERENITY-MARIAN OF ST. PAUL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EARL ST
SAINT PAUL MN
55106-6714
US

IV. Provider business mailing address

6499 UNIVERSITY AVE NE
MINNEAPOLIS MN
55432-4303
US

V. Phone/Fax

Practice location:
  • Phone: 651-793-2100
  • Fax: 651-771-4509
Mailing address:
  • Phone:
  • Fax:

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: TRICIA BERGIEN
Title or Position: ASSISTANT TREASURER
Credential:
Phone: 612-991-6519