Provider Demographics
NPI:1194044875
Name:THE FRIENDSHIP HOME COMMUNITY, LLC
Entity Type:Organization
Organization Name:THE FRIENDSHIP HOME COMMUNITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JOHANSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-398-2294
Mailing Address - Street 1:947 LYDIA DR W
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1923
Mailing Address - Country:US
Mailing Address - Phone:651-398-2294
Mailing Address - Fax:651-528-6216
Practice Address - Street 1:947 LYDIA DR W
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1923
Practice Address - Country:US
Practice Address - Phone:651-398-2294
Practice Address - Fax:651-528-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24337311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home