Provider Demographics
NPI:1326555756
Name:SANCTUARY BROOKLYN CENTER OPERATIONS, LLC
Entity Type:Organization
Organization Name:SANCTUARY BROOKLYN CENTER OPERATIONS, LLC
Other - Org Name:SANCTUARY AT BROOKLYN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL AL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-770-3751
Mailing Address - Street 1:6121 BROOKLYN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-4033
Mailing Address - Country:US
Mailing Address - Phone:763-312-6550
Mailing Address - Fax:
Practice Address - Street 1:6121 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-4033
Practice Address - Country:US
Practice Address - Phone:763-312-6550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility