MEDICARE: CERENITY SENIOR CARE

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	314000000X	Skilled Nursing Facility	327612	MN

General Provider Information

NPI Number	:	1558351890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CERENITY SENIOR CARE

Provider Business Mailing Address
First Line	:	724 19TH AVE N
Second Line	:
City	:	SOUTH ST PAUL
State	:	MN
Zip	:	55075-1301
Country	:	US
Telephone Number	:	651-232-6000
Fax Number	:	651-232-6111

Provider Business Practice Location Address
First Line	:	724 19TH AVE N
Second Line	:
City	:	SOUTH ST PAUL
State	:	MN
Zip	:	55075-1301
Country	:	US
Telephone Number	:	651-232-6000
Fax Number	:	651-232-6111

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHUCK HEIDBRINK
Credential	:
Telephone Number	:	651-793-2169

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	08/20/2007

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