Provider Demographics
NPI:1518910637
Name:CERENITY CARE CENTER-WHITE BEAR LAKE
Entity Type:Organization
Organization Name:CERENITY CARE CENTER-WHITE BEAR LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-232-1818
Mailing Address - Street 1:1900 WEBBER STREET
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3363
Mailing Address - Country:US
Mailing Address - Phone:651-232-1818
Mailing Address - Fax:651-232-1801
Practice Address - Street 1:1900 WEBBER STREET
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3363
Practice Address - Country:US
Practice Address - Phone:651-232-1818
Practice Address - Fax:651-232-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN253342100Medicaid
MN245300Medicare Oscar/Certification