Provider Demographics
NPI:1558027268
Name:SUITE LIVING SENIOR CARE OF SHAKOPEE
Entity Type:Organization
Organization Name:SUITE LIVING SENIOR CARE OF SHAKOPEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-770-2273
Mailing Address - Street 1:1824 BUERKLE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5245
Mailing Address - Country:US
Mailing Address - Phone:651-770-2273
Mailing Address - Fax:
Practice Address - Street 1:1645 WINDERMERE WAY
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-5507
Practice Address - Country:US
Practice Address - Phone:651-770-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility