Provider Demographics
NPI:1184715971
Name:SPRING GROVE ASSISTED LIVING LLC
Entity type:Organization
Organization Name:SPRING GROVE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMMERLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CHPN
Authorized Official - Phone:507-498-4000
Mailing Address - Street 1:130 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55974-1324
Mailing Address - Country:US
Mailing Address - Phone:507-498-4000
Mailing Address - Fax:507-498-4001
Practice Address - Street 1:130 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:MN
Practice Address - Zip Code:55974-1324
Practice Address - Country:US
Practice Address - Phone:507-498-4000
Practice Address - Fax:507-498-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility