Provider Demographics
NPI:1891976841
Name:HAWTHORNE HOUSE INC
Entity Type:Organization
Organization Name:HAWTHORNE HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSANTHI
Authorized Official - Middle Name:RENUKA
Authorized Official - Last Name:FERNANDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-385-9200
Mailing Address - Street 1:PO BOX 27482
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-0482
Mailing Address - Country:US
Mailing Address - Phone:612-385-9200
Mailing Address - Fax:763-205-1950
Practice Address - Street 1:6931 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4604
Practice Address - Country:US
Practice Address - Phone:612-385-9200
Practice Address - Fax:763-205-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23104310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility