MEDICINE LAKE MANOR (NPI# 1104221605) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104221605 |
| Entity Type | Organization |
| Organization Name | MEDICINE LAKE MANOR |
| Practice Address |
10230 28th Ave N Plymouth MN 55441 |
| Mailing Address |
10230 28th Ave N Plymouth MN 55441-3265 |
| Practice Telephone | 7635464017 |
| Mailing Telephone | 7635464017 |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2014-10-27 |
| Authorized Official Name | MS. ALLA G VAYNBERG (PRESIDENT/CEO) |
| Authorized Official Telephone | 7635464017 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 370431 | MN | Nursing & Custodial Care Facilities |
| Street Address |
10230 28TH AVE N |
| City | PLYMOUTH |
| State | MN |
| Zip Code | 55441 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902039076 | Alla G. Vaynberg | Durable Medical Equipment & Medical Supplies | 10230 28th Ave N, Plymouth, MN 55441-3265 | 2009-08-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689190019 | The Recovery Clinic LLC | Clinic/Center | 9800 Shelard Pkwy Ste 215, Plymouth, MN 55441 | 2017-08-17 |
| 1356887186 | Katherine Marlow Bell | Dentist | 2805 Campus Dr Ste 245, Plymouth, MN 55441 | 2017-01-18 |
| 1083069538 | Mercade Waldon | Home Health Aide | 3501 Xenium Lane, Plymouth, MN 55441 | 2016-05-03 |
| 1346645538 | Phs Westhealth, Inc | Skilled Nursing Facility | 2775 Campus Drive North, Plymouth, MN 55441 | 2014-10-30 |
| 1427453125 | Samuel David Fine | Pharmacist | 4070 Goldenrod Ln, Plymouth, MN 55441 | 2014-10-24 |
| 1548672538 | Scott Aaron Schmidt | Dentist | 2720 Annapolis Circle N, Suite A, Plymouth, MN 55441 | 2014-05-23 |
| 1831498633 | Comforide Transportation Services LLC | Non-emergency Medical Transport (VAN) | 9730 37th Pl N Suite 201, Plymouth, MN 55441 | 2011-03-18 |
| 1255669271 | Tammy Kae Mehlhaus | Physician Assistant | 2855 Campus Drive, Suite 570, Plymouth, MN 55441 | 2009-12-02 |
| 1164758199 | Stephen P. Boger, Dds, Pa | Dentist | 2720 Annapolis Circle, Suite A, Plymouth, MN 55441 | 2009-10-27 |
| 1093908360 | Endodontic Professionals Pa Plymouth Endodontics | Dentist | 3401 Hwy 169 N, Plymouth, MN 55441 | 2007-08-21 |
| Find all providers in zip 55441 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| 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. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316580277 | Nsh Plymouth-southern LLC | Assisted Living Facility | 930 E Clifford St, Plymouth, WI 53073-2451 | 2019-10-23 |
| 1740823145 | Two Sisters Holdings LLC | Assisted Living Facility | 18040 Medina Rd, Plymouth, MN 55446-2920 | 2019-10-18 |
| 1912549486 | Szr Northville Assisted Living, LLC | Assisted Living Facility | 16100 N Haggerty Rd, Plymouth, MI 48170-4857 | 2019-10-16 |
| 1497262224 | Rajo Care Home Inc | Assisted Living Facility | 14015 Rockford Rd, Plymouth, MN 55447 | 2018-01-02 |
| 1174947824 | Plymouth Senior Housing, LLC | Assisted Living Facility | 16205 36th Ave N, Plymouth, MN 55446-3374 | 2014-02-14 |
| 1164863395 | Joseph's Chateau LLC | Assisted Living Facility | 12715 42nd Pl N, Plymouth, MN 55442-2350 | 2013-07-16 |
| 1477740215 | A&r Open Door Inc | Assisted Living Facility | 14215 46th Pl N, Plymouth, MN 55446-3494 | 2007-09-25 |
| 1326163056 | B-xii Plymouth LLC | Assisted Living Facility | 157 South St, Plymouth, MA 02360-7605 | 2007-03-20 |
| 1720144363 | Brookdale Senior Living Communities, Inc. | Assisted Living Facility | 15855 22nd Ave N, Plymouth, MN 55447-6452 | 2006-12-28 |
| 1952319899 | Miller's Health Systems, Inc. | Assisted Living Facility | 625 Oakhill Ave, Plymouth, IN 46563-3064 | 2006-08-04 |
| Find all providers in PLYMOUTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.