Provider Demographics
NPI:1134278112
Name:CSL ROSE ARBOR
Entity type:Organization
Organization Name:CSL ROSE ARBOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-493-5910
Mailing Address - Street 1:16500 92ND AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-5444
Mailing Address - Country:US
Mailing Address - Phone:763-493-5910
Mailing Address - Fax:763-420-5728
Practice Address - Street 1:16500 92ND AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-5444
Practice Address - Country:US
Practice Address - Phone:763-493-5910
Practice Address - Fax:763-420-5728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL SENIOR LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-09
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN141657000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility