Provider Demographics
NPI:1003683913
Name:CHIMNEY PINES LLC
Entity Type:Organization
Organization Name:CHIMNEY PINES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHOUVIENG
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVILAY
Authorized Official - Suffix:
Authorized Official - Credentials:PS
Authorized Official - Phone:612-508-8743
Mailing Address - Street 1:10428 SHELTER GRV
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-4855
Mailing Address - Country:US
Mailing Address - Phone:612-508-8743
Mailing Address - Fax:
Practice Address - Street 1:10452 SPYGLASS DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-4656
Practice Address - Country:US
Practice Address - Phone:612-508-8743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility