Provider Demographics
NPI:1255736930
Name:SOJOURN ADULT DAY SERVICES LLC
Entity type:Organization
Organization Name:SOJOURN ADULT DAY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:HANCE
Authorized Official - Last Name:PENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-590-9250
Mailing Address - Street 1:5200 MAYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-1775
Mailing Address - Country:US
Mailing Address - Phone:952-471-6080
Mailing Address - Fax:
Practice Address - Street 1:5200 MAYWOOD RD
Practice Address - Street 2:
Practice Address - City:MOUND
Practice Address - State:MN
Practice Address - Zip Code:55364-1775
Practice Address - Country:US
Practice Address - Phone:952-471-6080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN802258-5-ADC261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care