Organization
ILHC OF EAGAN, LLC
Active
Other names
THE COMMONS ON MARICE
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DENISE GUSTAFSON (PRESIDENT)
(952) 361-8000
Entity
Organization
Contact information
Practice address
1380 MARICE DR, EAGAN, MN 55121-9748
(651) 688-9999
(651) 688-7888
Mailing address
1107 HAZELTINE BLVD, SUITE 200, CHASKA, MN 55318-1009
(952) 361-8000
(952) 361-8058
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
329867
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
344718900
—
MN
Enumeration date
06/09/2006
Last updated
07/11/2008
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