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General NPI Number Information
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NPI Number | 1669921912
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Entity Type | Organization
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Legal Business Name | EDINA SENIOR LIVING, LLC
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 6500 FRANCE AVE S
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City | EDINA
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State | MN
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Zip | 55435-1703
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Country | US
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Telephone | 952-848-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 6500 FRANCE AVE S
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City | EDINA
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State | MN
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Zip | 55435-1703
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Country | US
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Telephone | 952-848-8888
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. MARK THOMAS
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Credential |
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Telephone | 612-874-3460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | MN
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