Provider Demographics
NPI:1093050577
Name:EARLE BROWN TERRACE OPERATIONS LLC
Entity Type:Organization
Organization Name:EARLE BROWN TERRACE OPERATIONS LLC
Other - Org Name:EARLE BROWN TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP DIR OF ASSET MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUXO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-875-4500
Mailing Address - Street 1:400 LOCUST ST STE 820
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2334
Mailing Address - Country:US
Mailing Address - Phone:515-875-4500
Mailing Address - Fax:515-875-4780
Practice Address - Street 1:6100 SUMMIT DR N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2151
Practice Address - Country:US
Practice Address - Phone:763-560-6829
Practice Address - Fax:763-503-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility