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EVANS PARK INC NPI 1346730363


NPI Information

NPI: 1346730363
Provider Name: EVANS PARK, INC

Doing Business As: GUARDIAN ANGELS BY THE LAKE

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 24D1029222

Address:
13439 185TH LN NW
ELK RIVER, MN
ZIP 55330
Phone: (763) 241-7682
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EVANS PARK, INC is an assisted living facility in Elk River, 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. EVANS PARK, INC NPI is 1346730363. The provider is registered as an organization entity type.
The provider Is Doing Business As Guardian Angels By The Lake.

The provider's business location address is:

13439 185TH LN NW
ELK RIVER, MN
ZIP 55330-713
Phone: (763) 241-7682

The provider's authorized official is Troy Hanson .
The authorized official title is Vp, Cfo and has the following contact phone number (763) 241-4445.

The CLIA number assigned to this NPI record is 24D1029222 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/15/2018 and was last updated on 5/15/2018.


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
1310400000XAssisted Living FacilityYes

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
1A634929300OTHERMINNESOTAMN DEPARTMENT OF HUMAN SERVICES

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.