Basic Information
| Provider Information | |||||||||
| NPI: | 1588008676 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VILLA AT ST LOUIS PARK LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3701 W LUNT AVE | ||||||||
| Address2: | |||||||||
| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607122615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474402660 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7500 W 22ND ST | ||||||||
| Address2: | |||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554262602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525464261 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2013 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | ISRAEL | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8474402665 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.