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General NPI Number Information
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NPI Number | 1174514285
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Entity Type | Organization
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Legal Business Name | CERENITY SENIOR CARE
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 753 7TH ST E
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City | SAINT PAUL
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State | MN
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Zip | 55106-5025
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Country | US
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Telephone | 651-776-4107
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Fax | 651-776-5481
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Provider Business Mailing Address
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Address Line | 753 7TH ST E
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City | SAINT PAUL
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State | MN
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Zip | 55106-5025
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Country | US
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Telephone | 651-776-4107
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Fax | 651-776-5481
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. CHARLES HEIDBRINK
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Credential |
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Telephone | 651-793-2169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 327477
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 327332
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License Number State | MN
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