Organization
COLONY AT EDEN PRAIRIE, LLC
Active
Other names
The Colony at Eden Prairie TCU
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE DIDIER (PRESIDENT)
(952) 358-5100
Entity
Organization
Contact information
Practice address
429 PRAIRIE CENTER DR, EDEN PRAIRIE, MN 55344-5378
(952) 888-2923
Mailing address
429 PRAIRIE CENTER DR, EDEN PRAIRIE, MN 55344-5378
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
328765
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24-5611
MEDICARE ID-TYPE UNSPECIFIED
MN
01
—
245611
MEDICARE PROVIDER NUMBER
—
05
—
577468300
—
MN
01
—
7100424
MEDICA
MN
01
—
OR97CO
BCBS
MN
Enumeration date
04/26/2006
Last updated
08/08/2014
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