Provider Demographics
NPI:1891406336
Name:SUITE LIVING SENIOR CARE OF FOREST LAKE
Entity Type:Organization
Organization Name:SUITE LIVING SENIOR CARE OF FOREST LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
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 1:19839 HEADWATERS BLVD NORTH
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025
Mailing Address - Country:US
Mailing Address - Phone:651-770-2273
Mailing Address - Fax:651-666-1975
Practice Address - Street 1:19839 HEADWATERS BLVD NORTH
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025
Practice Address - Country:US
Practice Address - Phone:651-770-2273
Practice Address - Fax:651-666-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility