Provider Demographics
NPI:1366817819
Name:MSL-EBT LLC
Entity Type:Organization
Organization Name:MSL-EBT LLC
Other - Org Name:EARLE BROWN TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:TREFZGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-322-5535
Mailing Address - Street 1:PO BOX 2568
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-2568
Mailing Address - Country:US
Mailing Address - Phone:828-322-5535
Mailing Address - Fax:828-326-8115
Practice Address - Street 1:6100 SUMMIT DR N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2151
Practice Address - Country:US
Practice Address - Phone:763-560-6829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN375200310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility