Provider Demographics
NPI:1376007971
Name:SENIOR CARE OF MINNESOTA
Entity Type:Organization
Organization Name:SENIOR CARE OF MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-923-1028
Mailing Address - Street 1:4004 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55384-9656
Mailing Address - Country:US
Mailing Address - Phone:952-923-1028
Mailing Address - Fax:
Practice Address - Street 1:4004 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:SPRING PARK
Practice Address - State:MN
Practice Address - Zip Code:55384-9656
Practice Address - Country:US
Practice Address - Phone:952-923-1028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center