Provider Demographics
NPI:1477038966
Name:LEGACY OF BROWNSDALE, LLC
Entity Type:Organization
Organization Name:LEGACY OF BROWNSDALE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEIDRA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-203-1818
Mailing Address - Street 1:105 LATHAM ST NE
Mailing Address - Street 2:
Mailing Address - City:BROWNSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55918
Mailing Address - Country:US
Mailing Address - Phone:507-203-1818
Mailing Address - Fax:
Practice Address - Street 1:105 LATHAM ST NE
Practice Address - Street 2:
Practice Address - City:BROWNSDALE
Practice Address - State:MN
Practice Address - Zip Code:55918
Practice Address - Country:US
Practice Address - Phone:507-460-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility