Provider Demographics
NPI:1972034189
Name:KC COMPANIES OF SANDSTONE INC/SANDSTONE GOLDEN HORIZONS
Entity Type:Organization
Organization Name:KC COMPANIES OF SANDSTONE INC/SANDSTONE GOLDEN HORIZONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-568-6610
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:30184 OLD HWY 371
Mailing Address - City:PEQUOT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56472
Mailing Address - Country:US
Mailing Address - Phone:218-568-6610
Mailing Address - Fax:218-568-6642
Practice Address - Street 1:1109 LUNDORFF
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072
Practice Address - Country:US
Practice Address - Phone:320-216-7300
Practice Address - Fax:320-216-7022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility