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General NPI Number Information
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NPI Number | 1235629395
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Entity Type | Organization
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Legal Business Name | SUITE LIVING SENIOR MANAGEMENT
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 197 COUNTY ROAD B2 W
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City | ROSEVILLE
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State | MN
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Zip | 55127
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Country | US
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Telephone | 651-424-0046
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Fax |
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Provider Business Mailing Address
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Address Line | 1341 COUNTY ROAD D CIR E
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City | SAINT PAUL
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State | MN
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Zip | 55109-6004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | AUDREY MCELWAIN
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Credential |
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Telephone | 763-843-0779
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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 |
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