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General NPI Number Information
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NPI Number | 1346348612
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Entity Type | Organization
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Legal Business Name | WALKER RESIDENCE, INC.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 3701 BRYANT AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55409-1051
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Country | US
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Telephone | 612-827-8500
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Fax | 612-827-8535
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Provider Business Mailing Address
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Address Line | 11055 WAYZATA BLVD
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City | MINNETONKA
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State | MN
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Zip | 55305-1573
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Country | US
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Telephone | 320-763-1164
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Fax | 612-827-8431
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Authorized Official
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Title or Position | CFO
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Name | MARNIE MARIE GUGISBERG
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Credential |
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Telephone | 320-763-1164
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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 | 330805
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License Number State | MN
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