Provider Demographics
NPI:1245982297
Name:ARDEN GLADES ASSISTED LIVING LLC
Entity type:Organization
Organization Name:ARDEN GLADES ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTED LIVING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EFREN
Authorized Official - Middle Name:VALDEZ
Authorized Official - Last Name:MALONG
Authorized Official - Suffix:
Authorized Official - Credentials:LALD
Authorized Official - Phone:651-500-5339
Mailing Address - Street 1:9268 COMPASS POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-2007
Mailing Address - Country:US
Mailing Address - Phone:651-636-0925
Mailing Address - Fax:
Practice Address - Street 1:1474 FLORAL DR W
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-1903
Practice Address - Country:US
Practice Address - Phone:651-500-5339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility