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General NPI Number Information
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NPI Number | 1982085221
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Entity Type | Organization
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Legal Business Name | SAINT THERESE COLLABORATIVE, LLC
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 3300 OAKDALE AVE N 4TH FLOOR
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City | ROBBINSDALE
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State | MN
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Zip | 55422-2926
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Country | US
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Telephone | 952-983-2203
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Fax | 952-224-0991
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Provider Business Mailing Address
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Address Line | 1660 HIGHWAY 100 S STE 103
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-1529
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Country | US
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Telephone | 952-283-2203
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Fax | 952-224-0991
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Authorized Official
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Title or Position | CFO
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Name | CAL M SHELANGOSKI
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Credential |
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Telephone | 952-283-2204
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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 |
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