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General NPI Number Information
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NPI Number | 1780156208
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Entity Type | Organization
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Legal Business Name | CRESCENT COVE
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Dates
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Enumeration Date | 12/21/2018
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 4201 58TH AVD N.
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429
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Country | US
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Telephone | 952-426-4711
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Fax |
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Provider Business Mailing Address
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Address Line | 3440 BELTLINE BLVD. STE 207
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City | ST. LOUIS PARK
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State | MN
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Zip | 55416
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Country | US
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Telephone | 952-426-4711
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Fax |
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Authorized Official
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Title or Position | EXEC. DIRECTOR
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Name | KATHRYN J. LINDENFELSER
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Credential | MT-BC
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Telephone | 952-426-4711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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