MEDICARE: GOLDEN LODGE ASSISTED LIVING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1972458370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN LODGE ASSISTED LIVING LLC

Provider Business Mailing Address
First Line	:	3520 E RIVER RD NE
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55906-5407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 NEWSTAR WAY
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80403-8211
Country	:	US
Telephone Number	:	720-605-2111
Fax Number	:

Authorized Official
Title or Position	:	VP BUSINESS STRATEGY
Name	:	JORDAN RYAN
Credential	:
Telephone Number	:	507-251-6356

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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