Healthcare Provider Details

I. General information

NPI: 1144573643
Provider Name (Legal Business Name): ST. CLOUD SILVER LINING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 HWY 10 S, STE #1
ST. CLOUD MN
56304
US

IV. Provider business mailing address

1705 WEST ST. GERMAIN STREET
ST. CLOUD MN
56301
US

V. Phone/Fax

Practice location:
  • Phone: 320-230-1140
  • Fax:
Mailing address:
  • Phone: 320-230-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number359812
License Number StateMN

VIII. Authorized Official

Name: MR. BENJAMIN DALE ROSENBUSH
Title or Position: OWNER
Credential:
Phone: 320-230-1140