Provider Demographics
NPI:1477930006
Name:SENIOR CLASS CARE OF PEQUOT LAKES, INC.
Entity Type:Organization
Organization Name:SENIOR CLASS CARE OF PEQUOT LAKES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FEHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-232-1036
Mailing Address - Street 1:8898 SCHALLER ROAD, PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:PEQUOT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56472
Mailing Address - Country:US
Mailing Address - Phone:218-232-1036
Mailing Address - Fax:218-543-1035
Practice Address - Street 1:8898 SCHALLER ROAD
Practice Address - Street 2:
Practice Address - City:PEQUOT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56472
Practice Address - Country:US
Practice Address - Phone:218-543-1035
Practice Address - Fax:218-543-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility