Provider Demographics
NPI:1548958705
Name:ST. CLOUD CAREFREE LIVING
Entity type:Organization
Organization Name:ST. CLOUD CAREFREE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:651-451-0569
Mailing Address - Street 1:6205 CROSSMAN LN
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1852
Mailing Address - Country:US
Mailing Address - Phone:651-451-0569
Mailing Address - Fax:
Practice Address - Street 1:1225 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-0928
Practice Address - Country:US
Practice Address - Phone:320-251-6483
Practice Address - Fax:320-251-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health