Provider Demographics
NPI:1942649603
Name:CHERRYWOOD POINTE OF ROSEVILLE LLC
Entity Type:Organization
Organization Name:CHERRYWOOD POINTE OF ROSEVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:KWAMBOKA
Authorized Official - Last Name:MEKENYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-633-0044
Mailing Address - Street 1:2996 CLEVELAND AVE N
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4507
Mailing Address - Country:US
Mailing Address - Phone:651-633-0044
Mailing Address - Fax:651-633-4038
Practice Address - Street 1:2996 CLEVELAND AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4507
Practice Address - Country:US
Practice Address - Phone:651-633-0044
Practice Address - Fax:651-633-4038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility