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General NPI Number Information
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NPI Number | 1093685174
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Entity Type | Organization
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Legal Business Name | CRESTVIEW ASSISTED LIVING LLC
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 4458 RESERVOIR BLVD
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City | MINNEAPOLIS
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State | MN
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Zip | 55421-3271
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Country | US
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Telephone | 763-782-1611
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 CORPORATE CENTER CURV
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City | EAGAN
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State | MN
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Zip | 55121-1295
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSH LEGUM
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Credential |
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Telephone | 507-203-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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