Provider Demographics
NPI:1982085221
Name:SAINT THERESE COLLABORATIVE, LLC
Entity type:Organization
Organization Name:SAINT THERESE COLLABORATIVE, LLC
Other - Org Name:<UNAVAIL>
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 1:1660 HIGHWAY 100 S
Mailing Address - Street 2:STE 103
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1529
Mailing Address - Country:US
Mailing Address - Phone:952-283-2203
Mailing Address - Fax:952-224-0991
Practice Address - Street 1:3300 OAKDALE AVE N
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2926
Practice Address - Country:US
Practice Address - Phone:952-983-2203
Practice Address - Fax:952-224-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility