Provider Demographics
NPI:1265142624
Name:HSL 17, LLC
Entity type:Organization
Organization Name:HSL 17, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-709-0620
Mailing Address - Street 1:1295 NORTHLAND DR STE 270
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1373
Mailing Address - Country:US
Mailing Address - Phone:952-351-4552
Mailing Address - Fax:
Practice Address - Street 1:150 ASPIRE LN
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-2317
Practice Address - Country:US
Practice Address - Phone:612-709-0620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility