Provider Demographics
NPI:1225428048
Name:HEIKKILA, CHERYL
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:HEIKKILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12225 W SAVANNA RD
Mailing Address - Street 2:
Mailing Address - City:FLOODWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55736-8229
Mailing Address - Country:US
Mailing Address - Phone:218-326-2226
Mailing Address - Fax:
Practice Address - Street 1:2304 MCKINNEY LAKE RD
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4323
Practice Address - Country:US
Practice Address - Phone:218-326-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-01
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN371581310400000X
MN370000310400000X
MN1053221-2-AFC311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home