Provider Demographics
NPI:1245807510
Name:BROOKLYN PARK ASSISTED LIVING
Entity Type:Organization
Organization Name:BROOKLYN PARK ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-986-3859
Mailing Address - Street 1:PO BOX 46104
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-0104
Mailing Address - Country:US
Mailing Address - Phone:612-200-0901
Mailing Address - Fax:
Practice Address - Street 1:7711 HUMBOLDT AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55444-2167
Practice Address - Country:US
Practice Address - Phone:612-200-0901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility