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General NPI Number Information
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NPI Number | 1114232949
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Entity Type | Organization
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Legal Business Name | SEPTEMBER COTTAGE ELDERCARE
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Dates
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Enumeration Date | 08/17/2010
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 14145 205TH ST N
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City | SCANDIA
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State | MN
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Zip | 55073-9583
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Country | US
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Telephone | 651-433-4638
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Fax |
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Provider Business Mailing Address
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Address Line | 14145 205TH ST N
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City | SCANDIA
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State | MN
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Zip | 55073-9583
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Country | US
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Telephone | 651-433-4638
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MS. ALANA NICOLE SUNDBERG
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Credential |
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Telephone | 651-433-4638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 1057930-2-AFC
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License Number State | MN
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