Provider Demographics
NPI:1396839148
Name:ROBERT LENNARTSON
Entity Type:Organization
Organization Name:ROBERT LENNARTSON
Other - Org Name:NEW BEGINNINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:LENNARTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-458-0813
Mailing Address - Street 1:8251 INGLESIDE AVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016
Mailing Address - Country:US
Mailing Address - Phone:651-458-0813
Mailing Address - Fax:651-769-2620
Practice Address - Street 1:8251 INGLESIDE AVE SOUTH
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016
Practice Address - Country:US
Practice Address - Phone:651-458-0813
Practice Address - Fax:651-769-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN235363-4-AFC311ZA0620X
MN235363-2-AFC320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home