Provider Demographics
NPI:1285140251
Name:SANCTUARY ST. CLOUD OPERATIONS, LLC
Entity type:Organization
Organization Name:SANCTUARY ST. CLOUD OPERATIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL AL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-770-3751
Mailing Address - Street 1:2410 20TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56304-4708
Mailing Address - Country:US
Mailing Address - Phone:320-252-6325
Mailing Address - Fax:320-252-2276
Practice Address - Street 1:2410 20TH AVE SE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-4708
Practice Address - Country:US
Practice Address - Phone:320-252-6325
Practice Address - Fax:320-252-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility