1710195649 NPI number — MARION SENIOR DEVELOPMENT LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710195649 NPI number — MARION SENIOR DEVELOPMENT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARION SENIOR DEVELOPMENT LLC
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:
SUMMIT POINTE
Provider Other Organization Name Type Code:
3
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:
1710195649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3737 BRYANT AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55409-1019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-827-5931
Provider Business Mailing Address Fax Number:
612-827-8458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3505 ENGLISH GLEN CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-373-4242
Provider Business Practice Location Address Fax Number:
319-373-3013
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAUGEN
Authorized Official First Name:
DAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE SECRETARY
Authorized Official Telephone Number:
612-455-4015

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  S0248 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: S0248 . This is a "ASSISTED LIVING LICENSE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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