Provider Demographics
NPI:1043777469
Name:ASPEN GROVE PROPERTIES
Entity Type:Organization
Organization Name:ASPEN GROVE PROPERTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:GARGANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:218-966-6480
Mailing Address - Street 1:504 IRON DR
Mailing Address - Street 2:
Mailing Address - City:CHISHOLM
Mailing Address - State:MN
Mailing Address - Zip Code:55719-1989
Mailing Address - Country:US
Mailing Address - Phone:218-254-2750
Mailing Address - Fax:218-254-0164
Practice Address - Street 1:504 IRON DR
Practice Address - Street 2:
Practice Address - City:CHISHOLM
Practice Address - State:MN
Practice Address - Zip Code:55719-1989
Practice Address - Country:US
Practice Address - Phone:218-254-2750
Practice Address - Fax:218-254-0164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility