Provider Demographics
NPI:1164757464
Name:BLAINE WP, LLC
Entity Type:Organization
Organization Name:BLAINE WP, LLC
Other - Org Name:BLAINE WHITE PINE
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHILLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-287-0265
Mailing Address - Street 1:720 MAIN ST
Mailing Address - Street 2:205
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3757
Mailing Address - Country:US
Mailing Address - Phone:651-287-0265
Mailing Address - Fax:
Practice Address - Street 1:12446 JAMESTOWN STREET NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55559
Practice Address - Country:US
Practice Address - Phone:763-754-1930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility