Provider Demographics
NPI:1639843105
Name:ML OPERATOR, LLC
Entity Type:Organization
Organization Name:ML OPERATOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA, LALD
Authorized Official - Phone:651-216-7148
Mailing Address - Street 1:155 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2540
Mailing Address - Country:US
Mailing Address - Phone:952-214-4255
Mailing Address - Fax:612-339-1397
Practice Address - Street 1:155 5TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-2540
Practice Address - Country:US
Practice Address - Phone:952-214-4255
Practice Address - Fax:612-339-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility