Provider Demographics
NPI:1639689409
Name:CERENITY-MARIAN OF ST. PAUL, LLC
Entity Type:Organization
Organization Name:CERENITY-MARIAN OF ST. PAUL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-991-6519
Mailing Address - Street 1:6499 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 EARL ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-6714
Practice Address - Country:US
Practice Address - Phone:651-793-2100
Practice Address - Fax:651-771-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility