EBENEZER LAKES ASSISTED LIVING (NPI# 1679916571) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679916571 |
| 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 | 2013-04-10 |
| Last Update Date | 2016-12-30 |
| Authorized Official Name | MS. KARI BETH WILSON (CAMPUS DIRECTOR) |
| Authorized Official Telephone | 6519826228 |
| Authorized Official Credential | LNHA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Meadows on Fairview | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134441827 | Ebenezer Lakes Assisted Living | Assisted Living Facility | 25565 Fairview Ave, Wyoming, MN 55092-8053 | 2010-02-22 |
| Street Address |
25565 FAIRVIEW AVE |
| City | WYOMING |
| State | MN |
| Zip Code | 55092-8053 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134441827 | Ebenezer Lakes Assisted Living | Assisted Living Facility | 25565 Fairview Ave, Wyoming, MN 55092-8053 | 2010-02-22 |
| 1477968550 | Ebenezer Society, LLC | Home Health | 25565 Fairview Ave, Wyoming, MN 55092-8053 | 2014-06-26 |
| 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 | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326565862 | Healthbridge LLC | Skilled Nursing Facility | 2060 Health Dr Sw, Wyoming, MI 49519-9687 | 2017-08-25 |
| 1568591733 | Tendercare Michigan Inc. | Skilled Nursing Facility | 2786 56th St Sw, Wyoming, MI 49418-8708 | 2007-03-05 |
| 1376582254 | Heartland - Crestview Mi LLC | Skilled Nursing Facility | 625 36th St Sw, Wyoming, MI 49509-4004 | 2006-06-06 |
| 1073002606 | Crestview Snf, LLC | Skilled Nursing Facility | 625 36th St Sw, Wyoming, MI 49509 | 2018-05-09 |
| 1831596907 | Wyoming Opco, LLC | Skilled Nursing Facility | 2786 56th St Sw, Wyoming, MI 49418-8708 | 2014-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639707177 | Prairie Bluffs Rehabilitation Center LLC | Skilled Nursing Facility | 10300 Hennepin Town Rd, Eden Prairie, MN 55347-5100 | 2020-03-30 |
| 1881221869 | Natalie Sears | Skilled Nursing Facility | 1200 Cheri Ln Ne Apt 5, Fridley, MN 55421-1213 | 2020-03-26 |
| 1396210779 | Southview Operations LLC | Skilled Nursing Facility | 2000 Oakdale Avenue, West St. Paul, MN 55118 | 2018-10-11 |
| 1144707811 | Victory Health Operations, LLC | Skilled Nursing Facility | 512 - 49th Avenue North, Minneapolis, MN 55430-3621 | 2018-07-25 |
| 1710473434 | Cg Care Center, LLC. | Skilled Nursing Facility | 6993 80th Street South, Cottage Grove, MN 55016 | 2018-07-05 |
| 1457863466 | Seasons Healthcare of Trimont, Inc | Skilled Nursing Facility | 305 Broadway Avenue South, Trimont, MN 56176 | 2017-10-31 |
| 1760903157 | St. John's Lutheran Home | Skilled Nursing Facility | 1771 Eagle View Cir, Albert Lea, MN 56007-1817 | 2017-07-06 |
| 1114458221 | Lakeland Homecare LLC | Skilled Nursing Facility | 1604 Covington Ln, Eagan, MN 55122-2759 | 2017-03-22 |
| 1952842197 | Nsh Rochester East LLC | Skilled Nursing Facility | 501 8th Ave Se, Rochester, MN 55904-4834 | 2017-03-20 |
| 1750827234 | Walker Operations LLC | Skilled Nursing Facility | 209 Birchwood Avenue West, Walker, MN 56484 | 2017-01-09 |
| 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.