Provider Demographics
NPI:1336584606
Name:BRANDONS ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:BRANDONS ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-290-6527
Mailing Address - Street 1:305 CENTRAL AVE S
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MN
Mailing Address - Zip Code:56315-5802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 CENTRAL AVE S
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MN
Practice Address - Zip Code:56315-5802
Practice Address - Country:US
Practice Address - Phone:320-524-2208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN381347251E00000X
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health