Provider Demographics
NPI:1659675692
Name:AUGUSTANA ELK RUN ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:AUGUSTANA ELK RUN ASSISTED LIVING LLC
Other - Org Name:AUGUSTANA ELK RUN ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:KITTELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-238-5205
Mailing Address - Street 1:31383 FROST WAY
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-2217
Mailing Address - Country:US
Mailing Address - Phone:303-679-8777
Mailing Address - Fax:
Practice Address - Street 1:31383 FROST WAY
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-2217
Practice Address - Country:US
Practice Address - Phone:303-679-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility