EBENEZER LAKES ASSISTED LIVING (NPI# 1134441827) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134441827 |
| Entity Type | Organization |
| Organization Name | EBENEZER LAKES ASSISTED LIVING |
| Other Organization Name | MEADOWS ON FAIRVIEW |
| Practice Address |
25565 Fairview Ave Wyoming MN 55092-8053 |
| Practice Telephone | 6519826228 |
| Practice Fax Number | 6514660714 |
| Mailing Telephone | 6519826228 |
| Mailing Fax Number | 6514660714 |
| Enumeration Date | 2010-02-22 |
| Last Update Date | 2010-02-22 |
| Authorized Official Name | MS. KARI BETH WILSON (CAMPUS MANAGER) |
| Authorized Official Telephone | 6519826228 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 345526 | MN | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Meadows on Fairview | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679916571 | Ebenezer Lakes Assisted Living | Skilled Nursing Facility | 25565 Fairview Ave, Wyoming, MN 55092-8053 | 2013-04-10 |
| Street Address |
25565 FAIRVIEW AVE |
| City | WYOMING |
| State | MN |
| Zip Code | 55092-8053 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477968550 | Ebenezer Society, LLC | Home Health | 25565 Fairview Ave, Wyoming, MN 55092-8053 | 2014-06-26 |
| 1679916571 | Ebenezer Lakes Assisted Living | Skilled Nursing Facility | 25565 Fairview Ave, Wyoming, MN 55092-8053 | 2013-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821696022 | Wyoming Family Dental | Dentist | 5378 East Viking Blvd., Wyoming, MN 55092 | 2020-10-12 |
| 1851909436 | Matthew Rohlf | Dentist | 5378 E Viking Blvd, Wyoming, MN 55092 | 2020-07-20 |
| 1669013280 | Christina Marie Orde | Technician | 4855 261st Street, Wyoming, MN 55092 | 2019-10-04 |
| 1609425966 | Faith Bouttell | Technician | 25423 Heims Lake Circle, Wyoming, MN 55092 | 2019-09-10 |
| 1275875031 | Fairview Express Care | Clinic/Center | 5130 Fairview Blvd, Suite 101, Wyoming, MN 55092 | 2013-03-20 |
| 1023385242 | St. Croix Orthopaedics, P.a. | Durable Medical Equipment & Medical Supplies | 5200 Fairview Blvd., Wyoming, MN 55092 | 2011-11-17 |
| 1902851876 | Tamara Piroska Petrac-halatsis | Obstetrics & Gynecology | 5200 Fairview Boulevard, Ob/gyn Department, Wyoming, MN 55092 | 2006-05-22 |
| 1023502697 | Molly Levy | Nurse Practitioner | 5200 Fairview Blvd, Wyoming, MN 55092 | 2018-06-18 |
| 1588028955 | Kevin Anthony Brueske | Pediatrics | 5200 Fairview Blvd, Wyoming, MN 55092 | 2016-04-11 |
| 1376922070 | Carli Lynn Ceder | Physical Therapist | 5130 Fairview Blvd, Wyoming, MN 55092 | 2015-05-27 |
| Find all providers in zip 55092 | ||||
| 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 |
|---|---|---|---|---|
| 1306451679 | Traditions At Rivertown Park, LLC | Assisted Living Facility | 3555 Copper River Ave Sw, Wyoming, MI 49418-9791 | 2020-09-13 |
| 1104390566 | Naile Boshnjaku | Assisted Living Facility | 5408 Mills Ridge Dr Sw, Wyoming, MI 49418-8390 | 2019-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871193417 | Midwest Group Home | Assisted Living Facility | 4232 5th St Ne, Columbia Heights, MN 55421-2860 | 2020-10-30 |
| 1710587696 | Friesen & Friesen, Inc | Assisted Living Facility | 1971 Ne 1st Avenue, Grand Rapids, MN 55744 | 2020-10-29 |
| 1750980603 | Estherra Care LLC | Assisted Living Facility | 1120 Morgan Ave N, Minneapolis, MN 55411-3805 | 2020-10-21 |
| 1679189682 | Daniel Care Homes LLC | Assisted Living Facility | 6809 Perry Ave N, Brooklyn Center, MN 55429-1611 | 2020-09-16 |
| 1326651779 | Secured Health and Homecare Inc | Assisted Living Facility | 4519 104th Ave N, Brooklyn Park, MN 55443-1030 | 2020-08-26 |
| 1811509870 | Aurora Assisted Living LLC | Assisted Living Facility | 115 Magnolia Ave W, Saint Paul, MN 55117-4916 | 2020-08-20 |
| 1003427477 | In My Father's House | Assisted Living Facility | 3096 Snelling Ave N, Roseville, MN 55113-1659 | 2020-08-11 |
| 1710595863 | Eden Prairie Senior Living | Assisted Living Facility | 8480 Franlo Rd, Eden Prairie, MN 55344-2938 | 2020-07-15 |
| 1447868468 | Brightstar Services LLC | Assisted Living Facility | 1821 University Ave W Ste 120, Saint Paul, MN 55104-2811 | 2020-07-15 |
| 1235757667 | Roers Senior Living Buffalo LLC | Assisted Living Facility | 150 Division Street East, Buffalo, MN 55313 | 2020-07-13 |
| Find all providers with the same taxonomy | ||||
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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.