EBENEZER LAKES ASSISTED LIVING NPI 1134441827

NPI Information

NPI: 1134441827
Provider Name: EBENEZER LAKES ASSISTED LIVING

Doing Business As: MEADOWS ON FAIRVIEW

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
25565 FAIRVIEW AVE
WYOMING, MN
ZIP 55092
Phone: (651) 982-6228
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EBENEZER LAKES ASSISTED LIVING is an assisted living facility in Wyoming, MN. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. EBENEZER LAKES ASSISTED LIVING NPI is 1134441827. The provider is registered as an organization entity type.
The provider Is Doing Business As Meadows On Fairview.

The provider's business location address is:

25565 FAIRVIEW AVE
WYOMING, MN
ZIP 55092-053
Phone: (651) 982-6228
Fax: (651) 466-0714

The provider's authorized official is Kari Beth Wilson .
The authorized official title is Campus Manager and has the following contact phone number (651) 982-6228.

The enumeration date for this NPI number is 2/22/2010 and was last updated on 2/22/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		345526	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	A660928700	MEDICARE UPIN	MINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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