Provider Demographics
NPI:1619291721
Name:EAGLE'S CROSSING ADULT DAY CENTER
Entity Type:Organization
Organization Name:EAGLE'S CROSSING ADULT DAY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADULT DAY CENTER DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-285-3128
Mailing Address - Street 1:103 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:GREY EAGLE
Mailing Address - State:MN
Mailing Address - Zip Code:56336
Mailing Address - Country:US
Mailing Address - Phone:320-285-3128
Mailing Address - Fax:320-285-3128
Practice Address - Street 1:103 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GREY EAGLE
Practice Address - State:MN
Practice Address - Zip Code:56336
Practice Address - Country:US
Practice Address - Phone:320-285-3128
Practice Address - Fax:320-285-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1053344261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1053344OtherMINNESOTA DEPARTMENT OF HEALTH AND HUMAN SERVICES