MEDICARE: SANCTUARY ST. CLOUD OPERATIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1285140251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANCTUARY ST. CLOUD OPERATIONS, LLC

Provider Business Mailing Address
First Line	:	2410 20TH AVE SE
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56304-4708
Country	:	US
Telephone Number	:	320-252-6325
Fax Number	:	320-252-2276

Provider Business Practice Location Address
First Line	:	2410 20TH AVE SE
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56304-4708
Country	:	US
Telephone Number	:	320-252-6325
Fax Number	:	320-252-2276

Authorized Official
Title or Position	:	REGIONAL AL DIRECTOR
Name	:	JODY BARNEY
Credential	:
Telephone Number	:	612-770-3751

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	04/30/2019

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