Provider Demographics
NPI:1639445570
Name:CENTRAL MINNESOTA SENIOR HOUSING, LLC
Entity Type:Organization
Organization Name:CENTRAL MINNESOTA SENIOR HOUSING, LLC
Other - Org Name:SUNRISE OF BUFFALO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-682-5489
Mailing Address - Street 1:201 FIRST STREET NE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1550
Mailing Address - Country:US
Mailing Address - Phone:763-682-5489
Mailing Address - Fax:763-682-6511
Practice Address - Street 1:201 FIRST STREET NE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1550
Practice Address - Country:US
Practice Address - Phone:763-682-5489
Practice Address - Fax:763-682-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN352099310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility