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General NPI Number Information
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NPI Number | 1164757464
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Entity Type | Organization
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Legal Business Name | BLAINE WP, LLC
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Dates
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Enumeration Date | 10/05/2009
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Last Update Date | 10/05/2009
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Provider Practice Location Address
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Address Line | 12446 JAMESTOWN STREET NE
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City | BLAINE
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State | MN
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Zip | 55559
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Country | US
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Telephone | 763-754-1930
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Fax |
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Provider Business Mailing Address
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Address Line | 720 MAIN ST 205
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City | MENDOTA HEIGHTS
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State | MN
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Zip | 55118-3757
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Country | US
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Telephone | 651-287-0265
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MISS RHONDA K SCHILLINGER
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Credential |
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Telephone | 651-287-0265
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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 | MN
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