Provider Demographics
NPI:1386189991
Name:MS-AC MANKATO WE SENIOR LIVING LLC
Entity Type:Organization
Organization Name:MS-AC MANKATO WE SENIOR LIVING LLC
Other - Org Name:WATER'S EDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-595-6064
Mailing Address - Street 1:1300 SPRING ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3654
Mailing Address - Country:US
Mailing Address - Phone:240-595-6064
Mailing Address - Fax:
Practice Address - Street 1:800 AGENCY TRL
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6966
Practice Address - Country:US
Practice Address - Phone:507-388-5582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERISTAR ACAS HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility