MEDICARE: CENTER ONE APARTMENTS 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	:	1568291284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER ONE APARTMENTS LLC

Provider Business Mailing Address
First Line	:	1166 E 27TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4621
Country	:	US
Telephone Number	:	347-609-3119
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 10TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-1754
Country	:	US
Telephone Number	:	612-238-5555
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SETH PROBST
Credential	:
Telephone Number	:	612-238-5555

Provider Enumeration Date	:	07/31/2024
Last Update Date	:	07/31/2024

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Directions to “CENTER ONE APARTMENTS LLC ” Practice Location

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