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General NPI Number Information
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NPI Number | 1992877880
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Entity Type | Organization
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Legal Business Name | EDINA CARE RESIDENCE
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6802 DOVRE DR
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City | EDINA
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State | MN
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Zip | 55436-1715
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Country | US
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Telephone | 952-988-9900
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Fax | 952-988-0061
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Provider Business Mailing Address
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Address Line | 4205 LANCASTER LN N SUITE 109
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City | PLYMOUTH
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State | MN
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Zip | 55441-1700
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MARCIA DOONER
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Credential |
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Telephone | 763-550-1774
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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 | 21434
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License Number State | MN
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