Provider Demographics
NPI:1538433677
Name:CENTRAL MINNESOTA SENIOR HOUSING, LLC
Entity type:Organization
Organization Name:CENTRAL MINNESOTA SENIOR HOUSING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF ASSISTED LIVING OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-202-5037
Mailing Address - Street 1:4220 55TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8900
Mailing Address - Country:US
Mailing Address - Phone:507-286-8528
Mailing Address - Fax:507-286-8527
Practice Address - Street 1:4220 55TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8900
Practice Address - Country:US
Practice Address - Phone:507-286-8528
Practice Address - Fax:507-286-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility