Provider Demographics
NPI:1942650619
Name:THE HENDRICKS GROUP INC.
Entity Type:Organization
Organization Name:THE HENDRICKS GROUP INC.
Other - Org Name:BEACON HOME OF WEDGEWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-948-6597
Mailing Address - Street 1:1355 MENDOTA HEIGHTS RD STE 260
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1168
Mailing Address - Country:US
Mailing Address - Phone:651-451-2889
Mailing Address - Fax:651-451-5955
Practice Address - Street 1:10025 ANTRIM COURT
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129
Practice Address - Country:US
Practice Address - Phone:651-714-7075
Practice Address - Fax:651-344-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN375000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1700205556Medicaid
MN1528487378Medicaid
MN1598907131Medicaid
MN1437578283Medicaid
WI1720416357Medicaid