Provider Demographics
NPI:1003440124
Name:BEYOND SENIOR LIVING LLC
Entity Type:Organization
Organization Name:BEYOND SENIOR LIVING LLC
Other - Org Name:BEYOND SENIOR CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:SENAM
Authorized Official - Last Name:SAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-200-0857
Mailing Address - Street 1:6281 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2020
Mailing Address - Country:US
Mailing Address - Phone:651-493-3803
Mailing Address - Fax:651-200-3082
Practice Address - Street 1:6281 OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2020
Practice Address - Country:US
Practice Address - Phone:651-200-0857
Practice Address - Fax:651-200-3084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN638925Medicaid