Provider Demographics
NPI:1326226853
Name:PARK LANE ESTATES ASSISTED LIVING
Entity Type:Organization
Organization Name:PARK LANE ESTATES ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-692-6640
Mailing Address - Street 1:111 FILLMORE PL SE
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:MN
Mailing Address - Zip Code:55965-1140
Mailing Address - Country:US
Mailing Address - Phone:507-765-9986
Mailing Address - Fax:507-765-9987
Practice Address - Street 1:111 FILLMORE PL SE
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:MN
Practice Address - Zip Code:55965-1140
Practice Address - Country:US
Practice Address - Phone:507-765-9986
Practice Address - Fax:507-765-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5399731251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health