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General NPI Number Information
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NPI Number | 1164863395
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Entity Type | Organization
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Legal Business Name | JOSEPH'S CHATEAU LLC
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 11/26/2018
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Provider Practice Location Address
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Address Line | 12715 42ND PL N
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City | PLYMOUTH
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State | MN
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Zip | 55442-2350
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Country | US
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Telephone | 651-815-9250
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Fax | 651-688-0088
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Provider Business Mailing Address
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Address Line | 12715 42ND PL N
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City | PLYMOUTH
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State | MN
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Zip | 55442-2350
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Country | US
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Telephone | 651-815-9250
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Fax | 651-688-0088
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SHARON LYNN MOREY
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Credential | PH.D.
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Telephone | 651-815-9250
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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 | 2083936
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License Number State | MN
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