Provider Demographics
NPI:1710595863
Name:EDEN PRAIRIE SENIOR LIVING
Entity Type:Organization
Organization Name:EDEN PRAIRIE SENIOR LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNSTIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-370-1589
Mailing Address - Street 1:8480 FRANLO RD
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-2938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8480 FRANLO RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-2938
Practice Address - Country:US
Practice Address - Phone:651-370-1588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility