Healthcare Provider Details

I. General information

NPI: 1891070793
Provider Name (Legal Business Name): OAKGREEN COMMONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13936 LOWER 59TH ST N
OAK PARK HEIGHTS MN
55082-7065
US

IV. Provider business mailing address

13936 LOWER 59TH ST N
OAK PARK HEIGHTS MN
55082-7065
US

V. Phone/Fax

Practice location:
  • Phone: 651-439-9995
  • Fax: 651-454-4783
Mailing address:
  • Phone: 651-439-9995
  • Fax: 651-454-4783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number355161
License Number StateMN

VIII. Authorized Official

Name: LANCE E LEMIEUX
Title or Position: PRESIDENT
Credential:
Phone: 651-454-4801