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General NPI Number Information
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NPI Number | 1558652909
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Entity Type | Organization
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Legal Business Name | CHERRYWOOD ADVANCED LIVING, LLC
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 150 BARRY AVE NW
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City | RICHMOND
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State | MN
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Zip | 56368-4560
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Country | US
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Telephone | 320-597-6150
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Fax | 320-597-6151
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Provider Business Mailing Address
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Address Line | 1685 4TH AVE N
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City | SAUK RAPIDS
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State | MN
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Zip | 56379-2708
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Country | US
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Telephone | 320-257-7445
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Fax | 320-257-7447
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | WENDY HULSEBUS
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Credential |
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Telephone | 320-257-7445
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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 | 348548
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License Number State | MN
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