Healthcare Provider Details

I. General information

NPI: 1588374052
Provider Name (Legal Business Name): VILLAS AT ST PAUL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2022
Last Update Date: 11/25/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 GALTIER ST
SAINT PAUL MN
55103-2358
US

IV. Provider business mailing address

2361 NOSTRAND AVE STE 903
BROOKLYN NY
11210-3953
US

V. Phone/Fax

Practice location:
  • Phone: 651-224-1848
  • Fax:
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: JOSH LEGUM
Title or Position: PRESIDENT
Credential:
Phone: 507-203-1001