Provider Demographics
NPI:1255683660
Name:AJBB DULUTH PROPERTIES
Entity Type:Organization
Organization Name:AJBB DULUTH PROPERTIES
Other - Org Name:ANDERSON'S PINE GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BEAUCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-453-5554
Mailing Address - Street 1:633 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1449
Mailing Address - Country:US
Mailing Address - Phone:218-453-5554
Mailing Address - Fax:218-453-1014
Practice Address - Street 1:5130 HWY. 31
Practice Address - Street 2:
Practice Address - City:BROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:55711
Practice Address - Country:US
Practice Address - Phone:218-453-5554
Practice Address - Fax:218-453-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home