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Organization

LEGACY SENIOR SERVICES

Active
Other names
Traverse Care Center
Organization subpart
No

Provider details

NPI number
Authorized official
ERIC R LUNDE (BOARD MEMBER)
(612) 695-5618
Entity
Organization

Contact information

Practice address
303 7TH ST S, WHEATON, MN 56296-1740
(320) 563-8124
(320) 563-4133
Mailing address
303 7TH ST S, WHEATON, MN 56296-1740

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
00669
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
145240100
MN
01
9264TR
BCBS OF MINNESOTA
MN
Enumeration date
06/20/2005
Last updated
04/09/2020
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