| NPI | 1487971651 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACE LAYNE MCKENZIE Billing Supervisor/Admin Asst 952-697-4664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: MN 251E00000x) |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2011-04-12 |