CHERRYWOOD ADVANCED LIVING LLC NPI 1013350693

NPI Information

NPI: 1013350693
Provider Name: CHERRYWOOD ADVANCED LIVING, LLC

Doing Business As: CHERRYWOOD ST CLOUD 1036

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 24D2079441

Address:
1036 VOYAGEUR ST
ST CLOUD, MN
ZIP 56303
Phone: (320) 257-7445
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CHERRYWOOD ADVANCED LIVING, LLC is an assisted living facility in St Cloud, MN. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. CHERRYWOOD ADVANCED LIVING, LLC NPI is 1013350693. The provider is registered as an organization entity type.
The provider Is Doing Business As Cherrywood St Cloud 1036.

The provider's business location address is:

1036 VOYAGEUR ST
ST CLOUD, MN
ZIP 56303
Phone: (320) 257-7445
Fax: (320) 257-7447

The provider's authorized official is Wendy Hulsebus .
The authorized official title is Chief Operating Officer and has the following contact phone number (320) 257-7445.

The CLIA number assigned to this NPI record is 24D2079441 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/12/2013 and was last updated on 4/12/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		357491	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	360195	OTHER	MINNESOTA	HOUSING WITH SERVICES LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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