Provider Demographics
NPI:1821378183
Name:CHERRYWOOD ADVANCED LIVING, LLC
Entity Type:Organization
Organization Name:CHERRYWOOD ADVANCED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HULSEBUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-257-7445
Mailing Address - Street 1:1637 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-4596
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1637 4TH AVE N
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-4596
Practice Address - Country:US
Practice Address - Phone:320-257-7445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHERRYWOOD ADVANCED LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-18
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN352583310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN376870OtherCOMPREHENSIVE HOME CARE
MN353280OtherHOUSING WITH SERVICES MDH