Provider Demographics
NPI:1033415070
Name:ARBOR LAKES SENIOR LIVING
Entity Type:Organization
Organization Name:ARBOR LAKES SENIOR LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEMIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-454-4801
Mailing Address - Street 1:2285 WATERS DR
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1363
Mailing Address - Country:US
Mailing Address - Phone:651-454-4801
Mailing Address - Fax:
Practice Address - Street 1:12001 80TH AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:763-478-2141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3499403104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN349937OtherSTATE HOUSING WITH SERVICES
MN349940OtherMINNESOTA DEPARTMENT OF HEALTH