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General NPI Number Information
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NPI Number | 1588470660
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Entity Type | Organization
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Legal Business Name | AMERITUS EYOTA OPCO LLC
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 535 CANYON DRIVE NW
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City | EYOTA
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State | MN
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Zip | 55934
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Country | US
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Telephone | 570-545-3999
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Fax |
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Provider Business Mailing Address
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Address Line | 12900 WHITEWATER DRIVE SUITE 201
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City | MINNEAPOLIST
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State | MN
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Zip | 55343-9407
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Country | US
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Telephone | 763-537-5700
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Fax | 763-537-5700
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Authorized Official
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Title or Position | MANAGER
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Name | TOM WOLFE
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Credential |
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Telephone | 612-306-5566
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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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