Provider Demographics
NPI:1073011854
Name:CHERRYWOOD POINTE OF ROSEVILLE AT LEXINGTON LLC
Entity Type:Organization
Organization Name:CHERRYWOOD POINTE OF ROSEVILLE AT LEXINGTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HOUSING DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-874-3431
Mailing Address - Street 1:2680 LEXINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2188
Mailing Address - Country:US
Mailing Address - Phone:651-766-2266
Mailing Address - Fax:
Practice Address - Street 1:2680 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2188
Practice Address - Country:US
Practice Address - Phone:651-766-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility