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General NPI Number Information
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NPI Number | 1154556249
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Entity Type | Organization
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Legal Business Name | EPISCOPAL CORPORATION FOR THE ELDERLY
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 05/19/2009
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Provider Practice Location Address
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Address Line | 1850 UNIVERSITY AVE W MANAGEMENT OFFICE
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City | SAINT PAUL
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State | MN
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Zip | 55104-3930
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Country | US
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Telephone | 651-646-1026
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Fax | 651-632-8807
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Provider Business Mailing Address
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Address Line | 1850 UNIVERSITY AVE W MANAGEMENT OFFICE
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City | SAINT PAUL
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State | MN
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Zip | 55104-3930
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Country | US
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Telephone | 651-646-1026
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Fax | 651-632-8807
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Authorized Official
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Title or Position | ASSISTED LIVING MANAGER
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Name | MR. MARK W LADWIG
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Credential |
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Telephone | 651-646-1026
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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 | HWS341267
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License Number State | MN
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