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General NPI Number Information
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NPI Number | 1700136256
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Entity Type | Organization
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Legal Business Name | CHERRYWOOD POINTE OF ROSEVILLE, LLC
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 2996 CLEVELAND AVE N
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City | ROSEVILLE
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State | MN
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Zip | 55113
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Country | US
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Telephone | 651-633-0044
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Fax | 651-633-4038
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Provider Business Mailing Address
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Address Line | 2996 CLEVELAND AVE N
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City | ROSEVILLE
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State | MN
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Zip | 55113
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Country | US
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Telephone | 651-633-0044
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Fax | 651-633-4038
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CINDY L LEACH
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Credential |
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Telephone | 651-633-0044
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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 |
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License Number State | MN
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