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General NPI Number Information
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NPI Number | 1932722584
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Entity Type | Organization
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Legal Business Name | EVANS PARK, INC
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 05/18/2020
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Provider Practice Location Address
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Address Line | 9200 QUANTRELLE AVE NE
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City | OTSEGO
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State | MN
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Zip | 55330-1048
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Country | US
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Telephone | 763-746-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 508 FREEPORT AVE NW STE A
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City | ELK RIVER
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State | MN
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Zip | 55330-1874
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Country | US
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Telephone | 763-241-4428
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Fax |
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Authorized Official
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Title or Position | VP,CFO
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Name | TROY HANSON
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Credential |
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Telephone | 763-241-4445
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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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