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General NPI Number Information
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NPI Number | 1104173723
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Entity Type | Organization
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Legal Business Name | COVENTRY SENIOR LIVING OF MAPLEWOOD, LLC
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 1870 EAST SHORE DRIVE
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City | MAPLEWOOD
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State | MN
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Zip | 55109
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Country | US
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Telephone | 651-777-7784
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Fax | 651-344-0622
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Provider Business Mailing Address
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Address Line | 1870 EAST SHORE DRIVE
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City | MAPLEWOOD
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State | MN
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Zip | 55109
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Country | US
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Telephone | 651-777-7784
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Fax | 651-344-0622
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BARBARA RUPPE
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Credential |
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Telephone | 651-777-7784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | APPLIED FOR
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License Number State | MN
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