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General NPI Number Information
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NPI Number | 1780929257
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Entity Type | Organization
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Legal Business Name | MINNESOTA SENIOR LIVING LLC
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 04/14/2017
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Provider Practice Location Address
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Address Line | 3000 DOUGLAS DR N
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City | CRYSTAL
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State | MN
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Zip | 55422-2452
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Country | US
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Telephone | 763-544-6777
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Fax | 763-512-1772
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Provider Business Mailing Address
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Address Line | 915 118TH AVE SE 110
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City | BELLEVUE
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State | WA
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Zip | 98005-3819
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Country | US
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Telephone | 425-559-6301
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Fax | 425-559-6302
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Authorized Official
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Title or Position | DIRECTOR OF STRATEGIC PARTNERSHIPS
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Name | MARK MULLEN
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Credential |
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Telephone | 425-559-6301
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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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