Provider Demographics
NPI:1053687533
Name:EAGLE'S CROSSING ADULT DAY CENTER (MORA EAGLET)
Entity Type:Organization
Organization Name:EAGLE'S CROSSING ADULT DAY CENTER (MORA EAGLET)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADULT DAY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-285-3128
Mailing Address - Street 1:133 UNION ST S STE 4
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-1579
Mailing Address - Country:US
Mailing Address - Phone:320-285-3128
Mailing Address - Fax:
Practice Address - Street 1:133 UNION ST S STE 4
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1579
Practice Address - Country:US
Practice Address - Phone:320-285-3128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1062197261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care