=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720687411
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LASHIA ELDERLY CARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2020
-----------------------------------------------------
Last Update Date | 10/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2355 ARIEL ST N
-----------------------------------------------------
City | MAPLEWOOD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55109-2275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-379-0005
-----------------------------------------------------
Fax | 651-788-7503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2355 ARIEL ST N
-----------------------------------------------------
City | MAPLEWOOD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55109-2275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-379-0005
-----------------------------------------------------
Fax | 651-788-7503
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | NOM FUE THAO
-----------------------------------------------------
Credential | ESQ.
-----------------------------------------------------
Telephone | 651-379-0005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------