Organization
WEST BLOOMINGTON RESIDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCIA SUE DOONER (DIRECTOR)
(763) 550-1774
Entity
Organization
Contact information
Practice address
10441 JOHNSON AVE S, MINNEAPOLIS, MN 55437-2819
(763) 550-1774
Mailing address
10441 JOHNSON AVE S, MINNEAPOLIS, MN 55437-2819
(763) 550-1774
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
334473
MN
310400000X
Assisted Living Facility
—
—
Other
Enumeration date
03/16/2007
Last updated
04/25/2008
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