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General NPI Number Information
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NPI Number | 1164660817
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Entity Type | Organization
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Legal Business Name | LAKES AREA ASSISTED LIVING LLC
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 1313 COUNTY ROAD 22 NW
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City | ALEXANDRIA
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State | MN
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Zip | 56308-4957
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Country | US
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Telephone | 320-759-5600
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Fax | 320-763-5007
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Provider Business Mailing Address
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Address Line | 1313 COUNTY ROAD 22 NW
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City | ALEXANDRIA
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State | MN
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Zip | 56308-4957
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Country | US
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Telephone | 320-759-5600
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Fax | 320-763-5007
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DIANE MARIE ZIEBELL
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Credential |
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Telephone | 320-759-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 342894
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License Number State | MN
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