Provider Demographics
NPI:1003130154
Name:CALEY HOUSE
Entity Type:Organization
Organization Name:CALEY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE ACCOUNTS RECEIVABLE MGR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MICKELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-259-4485
Mailing Address - Street 1:104 SOUTH 8TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-1735
Mailing Address - Country:US
Mailing Address - Phone:763-389-0424
Mailing Address - Fax:763-389-0436
Practice Address - Street 1:104 SOUTH 8TH AVENUE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1735
Practice Address - Country:US
Practice Address - Phone:763-389-0424
Practice Address - Fax:763-389-0436
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIM HOMES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34436310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility