Provider Demographics
NPI:1760618607
Name:METROPOLITAN LIVING, LLC
Entity Type:Organization
Organization Name:METROPOLITAN LIVING, LLC
Other - Org Name:MATILDE HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LADC
Authorized Official - Phone:612-226-7120
Mailing Address - Street 1:2105 W BURNSVILLE PKWY
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4237
Mailing Address - Country:US
Mailing Address - Phone:952-564-3006
Mailing Address - Fax:952-746-7897
Practice Address - Street 1:9230 5TH AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-3812
Practice Address - Country:US
Practice Address - Phone:952-888-1194
Practice Address - Fax:952-888-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN26106OtherMN DEPARTMENT OF HEALTH REGISTRATION
MN162386OtherUCARE
MN348730OtherCLASS F HOME CARE PROVIDER
MN348244OtherHOUSING WITH SERVICES