Provider Demographics
NPI:1386635183
Name:CERENITY SENIOR CARE
Entity Type:Organization
Organization Name:CERENITY SENIOR CARE
Other - Org Name:CERENITY CARE CENTER - MARIAN OF SAINT PAUL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-793-2100
Mailing Address - Street 1:200 EARL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-6714
Mailing Address - Country:US
Mailing Address - Phone:651-793-2100
Mailing Address - Fax:651-771-4509
Practice Address - Street 1:200 EARL ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-6714
Practice Address - Country:US
Practice Address - Phone:651-793-2100
Practice Address - Fax:651-771-4509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CERENITY SENIOR CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-31
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330632314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
245365BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER