Provider Demographics
NPI:1699146035
Name:SAINT THERESE OF WOODBURY, LLC
Entity type:Organization
Organization Name:SAINT THERESE OF WOODBURY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHELANGOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-283-2204
Mailing Address - Street 1:7555 BAILEY ROAD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129
Mailing Address - Country:US
Mailing Address - Phone:651-209-9100
Mailing Address - Fax:952-224-0128
Practice Address - Street 1:7555 BAILEY ROAD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129
Practice Address - Country:US
Practice Address - Phone:651-209-9100
Practice Address - Fax:952-224-0128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility