Provider Demographics
NPI:1225189624
Name:SPRING PARK CENTER LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:SPRING PARK CENTER LIMITED PARTNERSHIP
Other - Org Name:OLD MAIN VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-361-8000
Mailing Address - Street 1:1107 HAZELTINE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1009
Mailing Address - Country:US
Mailing Address - Phone:952-361-8000
Mailing Address - Fax:952-361-8058
Practice Address - Street 1:301 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7507
Practice Address - Country:US
Practice Address - Phone:507-388-4200
Practice Address - Fax:507-388-5991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility