Healthcare Provider Details

I. General information

NPI: 1396280657
Provider Name (Legal Business Name): MEADOW LANE OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 UTAH AVE
BENSON MN
56215-1000
US

IV. Provider business mailing address

2209 UTAH AVE
BENSON MN
56215-1000
US

V. Phone/Fax

Practice location:
  • Phone: 320-843-2225
  • Fax: 320-843-2496
Mailing address:
  • Phone: 320-843-2225
  • Fax: 320-843-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. EPHRAM LAHASKY
Title or Position: PRESIDENT
Credential:
Phone: 646-772-3668