1639591894 NPI number — CERENITY SENIOR CARE

Table of content: (NPI 1639591894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639591894 NPI number — CERENITY SENIOR CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CERENITY SENIOR CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CERENITY DAYAWAY - ST AMBROSE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639591894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 EARL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55106-6714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-793-2100
Provider Business Mailing Address Fax Number:
651-771-4509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4125 WOODBURY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55129-9627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-714-1058
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
THORNE
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR/CEO
Authorized Official Telephone Number:
651-793-2101

Provider Taxonomy Codes

  • Taxonomy code: 385H00000X , with the licence number:  1064785-1-ADC , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com