# NORTH STAR CLUB, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609276724
- **Authorized official:** JASON FISCHER (MANAGER)
- **Authorized official phone:** (952) 426-6219

## Contact information

- **Practice address:** 8040 OLD CEDAR AVE S, BLOOMINGTON, MN 55425-1234
- **Practice address phone:** (952) 542-6219
- **Mailing address:** 8040 OLD CEDAR AVE S, BLOOMINGTON, MN 55425-1234

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | 1066119 | MN | Yes |

## Other

- **Enumeration date:** 08/26/2014
- **Last updated:** 08/26/2014