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General NPI Number Information
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NPI Number | 1619291721
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Entity Type | Organization
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Legal Business Name | EAGLE'S CROSSING ADULT DAY CENTER
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 103 SPRUCE ST
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City | GREY EAGLE
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State | MN
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Zip | 56336
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Country | US
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Telephone | 320-285-3128
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Fax | 320-285-3128
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Provider Business Mailing Address
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Address Line | 103 SPRUCE ST
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City | GREY EAGLE
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State | MN
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Zip | 56336
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Country | US
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Telephone | 320-285-3128
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Fax | 320-285-3128
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Authorized Official
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Title or Position | OWNER/ADULT DAY CENTER DIRECTOR
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Name | MRS. DIANE KAY KRAMER
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Credential |
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Telephone | 320-285-3128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 1053344
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License Number State | MN
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