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General NPI Number Information
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NPI Number | 1164848362
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Entity Type | Organization
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Legal Business Name | PHS/ COTTAGE GROVE
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 8200 HADLEY AVE S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-2697
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Country | US
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Telephone | 651-769-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 2845 HAMLINE AVE N
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City | ROSEVILLE
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State | MN
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Zip | 55113-7127
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Country | US
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Telephone | 651-631-6432
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Fax | 651-631-6122
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Authorized Official
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Title or Position | CFO
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Name | MR. MARK MEYER
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Credential |
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Telephone | 651-631-6102
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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 | 357333
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License Number State | MN
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