Provider Demographics
NPI:1083847610
Name:INVERWOOD SENIOR LIVING LLC
Entity Type:Organization
Organization Name:INVERWOOD SENIOR LIVING LLC
Other - Org Name:INVER GLEN SENIOR LIVING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-312-4481
Mailing Address - Street 1:1984 OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:W ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3553
Mailing Address - Country:US
Mailing Address - Phone:651-450-0707
Mailing Address - Fax:651-455-0267
Practice Address - Street 1:7260 SO. ROBERT TRAIL
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077
Practice Address - Country:US
Practice Address - Phone:651-450-0707
Practice Address - Fax:651-455-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances