MEDICARE: AUGUSTANA COMMUNITY PARTNERS

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	361970	MN

General Provider Information

NPI Number	:	1679994636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUGUSTANA COMMUNITY PARTNERS

Provider Business Mailing Address
First Line	:	2533 1ST AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4342
Country	:	US
Telephone Number	:	612-821-2190
Fax Number	:	612-872-4472

Provider Business Practice Location Address
First Line	:	2533 1ST AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4342
Country	:	US
Telephone Number	:	612-821-2190
Fax Number	:	612-872-4472

Authorized Official
Title or Position	:	CFO
Name	:	CRAIG KITTELSON
Credential	:
Telephone Number	:	612-238-5205

Provider Enumeration Date	:	12/18/2013
Last Update Date	:	12/18/2013

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