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General NPI Number Information
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NPI Number | 1003172594
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Entity Type | Organization
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Legal Business Name | MOUNT OLIVET ROLLING ACRES, INC
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 08/01/2013
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Provider Practice Location Address
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Address Line | 1603 W OLD SHAKOPEE RD
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City | BLOOMINGTON
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State | MN
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Zip | 55431-3065
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Country | US
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Telephone | 952-401-4868
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Fax |
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Provider Business Mailing Address
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Address Line | 18986 LAKE DR E
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City | CHANHASSEN
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State | MN
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Zip | 55317-9348
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Country | US
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Telephone | 952-474-5974
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Fax | 952-474-3652
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KARI DOSE
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Credential |
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Telephone | 952-401-4843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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