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General NPI Number Information
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NPI Number | 1578452934
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Entity Type | Organization
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Legal Business Name | 828 1ST STREET NE OPCO LLC
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 828 1ST ST NE
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City | FARIBAULT
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State | MN
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Zip | 55021-5438
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Country | US
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Telephone | 507-385-7099
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Fax | 612-360-2331
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Provider Business Mailing Address
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Address Line | 5900 CLEARWATER DR STE 500
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City | MINNETONKA
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State | MN
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Zip | 55343-8961
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Country | US
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Telephone | 763-486-9187
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Fax | 612-360-2331
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Authorized Official
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Title or Position | CLINICAL REIMBURSEMENT MANAGER
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Name | KATE RYG
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Credential |
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Telephone | 763-486-9187
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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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