Provider Demographics
NPI:1871511790
Name:HIGHLAND CHATEAU SUITES, LLC
Entity Type:Organization
Organization Name:HIGHLAND CHATEAU SUITES, LLC
Other - Org Name:HIGHLAND CHATEAU HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGOTZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-537-5700
Mailing Address - Street 1:12900 WHITEWATER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9407
Mailing Address - Country:US
Mailing Address - Phone:763-537-5700
Mailing Address - Fax:
Practice Address - Street 1:2319 7TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-2813
Practice Address - Country:US
Practice Address - Phone:651-690-8233
Practice Address - Fax:651-690-8232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331933314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5J10HIOtherBLUE CROSS BLUE SHIELD
MN110115300Medicaid
MNNH0073OtherUCARE