Provider Demographics
NPI:1073749040
Name:ARBOR PARK VILLAGE, LLC
Entity Type:Organization
Organization Name:ARBOR PARK VILLAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:218-359-9999
Mailing Address - Street 1:520 28TH ST N
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2441
Mailing Address - Country:US
Mailing Address - Phone:218-359-9999
Mailing Address - Fax:218-359-0890
Practice Address - Street 1:520 28TH ST N
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2441
Practice Address - Country:US
Practice Address - Phone:218-359-9999
Practice Address - Fax:218-359-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343693310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility