Provider Demographics
NPI:1558351890
Name:CERENITY SENIOR CARE
Entity Type:Organization
Organization Name:CERENITY SENIOR CARE
Other - Org Name:CERENITY CARE CENTER BETHESDA ST PAUL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDBRINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-793-2169
Mailing Address - Street 1:724 19TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SOUTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-1301
Mailing Address - Country:US
Mailing Address - Phone:651-232-6000
Mailing Address - Fax:651-232-6111
Practice Address - Street 1:724 19TH AVE N
Practice Address - Street 2:
Practice Address - City:SOUTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55075-1301
Practice Address - Country:US
Practice Address - Phone:651-232-6000
Practice Address - Fax:651-232-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327612314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245003Medicare ID - Type Unspecified