Provider Demographics
NPI:1518943596
Name:AUBURN MANOR
Entity Type:Organization
Organization Name:AUBURN MANOR
Other - Org Name:AUBURN COURTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-361-0340
Mailing Address - Street 1:501 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2072
Mailing Address - Country:US
Mailing Address - Phone:952-448-9303
Mailing Address - Fax:952-361-0305
Practice Address - Street 1:501 N OAK ST
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2072
Practice Address - Country:US
Practice Address - Phone:952-448-9303
Practice Address - Fax:952-361-0305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORAVIAN CARE MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-21
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN329054310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN422243100Medicaid
MN422243100Medicaid