=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033260369
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CFHGROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2007
-----------------------------------------------------
Last Update Date | 06/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 912 KNOB HILL RD
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55337-4325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-889-8056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17595 260TH ST
-----------------------------------------------------
City | SHAFER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55074-9629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-257-8146
-----------------------------------------------------
Fax | 651-257-9245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. ROBERT ROY CARDENAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 612-670-1380
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------