Provider Demographics
NPI:1902189350
Name:MARGARET PLACE LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:MARGARET PLACE LIMITED PARTNERSHIP
Other - Org Name:DBA: DEMAR CATERED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HOUSING WITH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-862-5484
Mailing Address - Street 1:1555 118TH LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-7579
Mailing Address - Country:US
Mailing Address - Phone:763-862-5430
Mailing Address - Fax:763-754-0332
Practice Address - Street 1:11777 XEON BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-2060
Practice Address - Country:US
Practice Address - Phone:763-755-8174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN350791310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA773143000Medicaid