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General NPI Number Information
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NPI Number | 1649669193
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Entity Type | Organization
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Legal Business Name | THE LODGES COMPANY
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 11/01/2019
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Provider Practice Location Address
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Address Line | 1412 SUMMIT OAKS DR
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City | BURNSVILLE
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State | MN
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Zip | 55337-4744
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Country | US
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Telephone | 612-986-3859
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 46104
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City | PLYMOUTH
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State | MN
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Zip | 55446-0104
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Country | US
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Telephone | 952-222-3395
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Fax | 612-524-5494
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Authorized Official
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Title or Position | TREASURER
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Name | MR. MICHAEL CROW
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Credential |
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Telephone | 612-986-3859
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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 |
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License Number State |
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