Provider Demographics
NPI:1326699976
Name:ONALASKA SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:ONALASKA SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-827-8357
Mailing Address - Street 1:3737 BRYANT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1019
Mailing Address - Country:US
Mailing Address - Phone:612-827-8357
Mailing Address - Fax:612-827-8431
Practice Address - Street 1:3770 EMERALD DR E
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-6743
Practice Address - Country:US
Practice Address - Phone:608-781-0414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility