Healthcare Provider Details

I. General information

NPI: 1285557520
Provider Name (Legal Business Name): SUITE LIVING SENIOR CARE OF CORCORAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7325 BROCKTON LANE NORTH
CORCORAN MN
55340
US

IV. Provider business mailing address

1824 BUERKLE RD
WHITE BEAR LAKE MN
55110-5245
US

V. Phone/Fax

Practice location:
  • Phone: 651-770-2273
  • Fax:
Mailing address:
  • Phone: 651-770-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: AUDREY MCELWAIN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 651-770-2273