Provider Demographics
NPI:1588018071
Name:ARLINGTON VOA ALR OPERATING, INC.
Entity Type:Organization
Organization Name:ARLINGTON VOA ALR OPERATING, INC.
Other - Org Name:MARY MARSHALL RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-983-4249
Mailing Address - Street 1:7530 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3636
Mailing Address - Country:US
Mailing Address - Phone:952-983-4249
Mailing Address - Fax:952-941-0428
Practice Address - Street 1:2000 5TH ST S
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1902
Practice Address - Country:US
Practice Address - Phone:571-527-5000
Practice Address - Fax:571-527-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1104252L1553104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness