Provider Demographics
NPI:1639591894
Name:CERENITY SENIOR CARE
Entity Type:Organization
Organization Name:CERENITY SENIOR CARE
Other - Org Name:CERENITY DAYAWAY - ST AMBROSE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-793-2101
Mailing Address - Street 1:200 EARL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-6714
Mailing Address - Country:US
Mailing Address - Phone:651-793-2100
Mailing Address - Fax:651-771-4509
Practice Address - Street 1:4125 WOODBURY DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-9627
Practice Address - Country:US
Practice Address - Phone:651-714-1058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CERENITY SENIOR CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1064785-1-ADC385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care