Provider Demographics
NPI:1609499664
Name:VAIMAR SUITES LLC
Entity Type:Organization
Organization Name:VAIMAR SUITES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MUMBUWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-221-7318
Mailing Address - Street 1:4845 FERNCROFT DR
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-8750
Mailing Address - Country:US
Mailing Address - Phone:952-221-7318
Mailing Address - Fax:651-521-4223
Practice Address - Street 1:7900 DOUGLAS DR N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-2046
Practice Address - Country:US
Practice Address - Phone:763-432-3008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances