1679868947 NPI number — KNUTE NELSON SENIOR LIVING CAMPUS, 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 1679868947 NPI number — KNUTE NELSON SENIOR LIVING CAMPUS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KNUTE NELSON SENIOR LIVING CAMPUS, 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:
Provider Other Organization Name Type Code:
6
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:
1679868947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 12TH AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56308-2612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-763-1164
Provider Business Mailing Address Fax Number:
320-763-7548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4403 PIONEER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-763-1600
Provider Business Practice Location Address Fax Number:
320-763-7548
Provider Enumeration Date:
06/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GUGISBERG
Authorized Official First Name:
MARNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
320-763-1164

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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