Provider Demographics
NPI:1679868947
Name:KNUTE NELSON SENIOR LIVING CAMPUS, LLC
Entity Type:Organization
Organization Name:KNUTE NELSON SENIOR LIVING CAMPUS, LLC
Other - Org Name:GRAND ARBOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUGISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-763-1164
Mailing Address - Street 1:420 12TH AVE E
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2612
Mailing Address - Country:US
Mailing Address - Phone:320-763-1164
Mailing Address - Fax:320-763-7548
Practice Address - Street 1:4403 PIONEER ROAD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308
Practice Address - Country:US
Practice Address - Phone:320-763-1600
Practice Address - Fax:320-763-7548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility