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General NPI Number Information
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NPI Number | 1588166805
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Entity Type | Organization
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Legal Business Name | GOLDEN ELDERLY CARE SUITES LLC
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 03/02/2018
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Provider Practice Location Address
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Address Line | 7245 HIDDEN HOLLOW CT
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City | SAINT PAUL
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State | MN
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Zip | 55112-3836
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Country | US
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Telephone | 736-447-7717
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Fax | 651-484-5130
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Provider Business Mailing Address
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Address Line | 1066 SHERWOOD RD
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City | SHOREVIEW
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State | MN
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Zip | 55126-8429
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Country | US
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Telephone | 763-447-7717
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | NANCY HUELMA STRANDLUND
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Credential |
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Telephone | 763-447-7717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 382983
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License Number State | MN
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