Organization
THE HOMESTEAD AT COON RAPIDS, INC.
Active
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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