Organization
THE HOMESTEAD AT COON RAPIDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY GAVIN (ASSISTANT SECRETARY)
(952) 983-4249
Entity
Organization
Contact information
Practice address
1770 113TH LN NW, COON RAPIDS, MN 55433-3019
(763) 754-2800
(763) 754-4800
Mailing address
1770 113TH LN NW, COON RAPIDS, MN 55433-3019
(763) 754-2800
(763) 754-4800
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MN
Enumeration date
03/11/2019
Last updated
02/05/2021
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