=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992857551
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARECO APARTMENTS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6115 CARMEN AVE
-----------------------------------------------------
City | INVER GROVE HEIGHTS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55076-4421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-451-1756
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6115 CARMEN AVE
-----------------------------------------------------
City | INVER GROVE HEIGHTS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55076-4421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-451-1756
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | GARY NOBLE
-----------------------------------------------------
Credential | M.S.
-----------------------------------------------------
Telephone | 651-451-1756
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 315P00000X
-----------------------------------------------------
Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
-----------------------------------------------------
License Number | 10448941RS
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------