Provider Demographics
NPI:1457475204
Name:MINNEOTA RESIDENTIAL SERVICES LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:MINNEOTA RESIDENTIAL SERVICES LIMITED PARTNERSHIP
Other - Org Name:MADISON AVENUE APARTMENTS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-872-5300
Mailing Address - Street 1:700 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MINNEOTA
Mailing Address - State:MN
Mailing Address - Zip Code:56264-9373
Mailing Address - Country:US
Mailing Address - Phone:507-872-5300
Mailing Address - Fax:507-872-5359
Practice Address - Street 1:700 N MADISON ST
Practice Address - Street 2:
Practice Address - City:MINNEOTA
Practice Address - State:MN
Practice Address - Zip Code:56264-9373
Practice Address - Country:US
Practice Address - Phone:507-872-5300
Practice Address - Fax:507-872-5359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN333925310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility