Provider Demographics
NPI:1114232949
Name:SEPTEMBER COTTAGE ELDERCARE
Entity Type:Organization
Organization Name:SEPTEMBER COTTAGE ELDERCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SUNDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-433-4638
Mailing Address - Street 1:14145 205TH ST N
Mailing Address - Street 2:
Mailing Address - City:SCANDIA
Mailing Address - State:MN
Mailing Address - Zip Code:55073-9583
Mailing Address - Country:US
Mailing Address - Phone:651-433-4638
Mailing Address - Fax:
Practice Address - Street 1:14145 205TH ST N
Practice Address - Street 2:
Practice Address - City:SCANDIA
Practice Address - State:MN
Practice Address - Zip Code:55073-9583
Practice Address - Country:US
Practice Address - Phone:651-433-4638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1057930-2-AFC311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home