Provider Demographics
NPI:1104359827
Name:MINNESOTA SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:MINNESOTA SENIOR LIVING, LLC
Other - Org Name:THE RIVERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:ENSIGN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-890-8553
Mailing Address - Street 1:11111 RIVER HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3259
Mailing Address - Country:US
Mailing Address - Phone:952-890-8553
Mailing Address - Fax:952-890-9320
Practice Address - Street 1:11111 RIVER HILLS DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-3259
Practice Address - Country:US
Practice Address - Phone:952-890-8553
Practice Address - Fax:950-890-9320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN378575310400000X
MN380943310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility