Provider Demographics
NPI:1720144363
Name:BROOKDALE SENIOR LIVING COMMUNITIES, INC.
Entity Type:Organization
Organization Name:BROOKDALE SENIOR LIVING COMMUNITIES, INC.
Other - Org Name:BROOKDALE PLYMOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-918-5443
Mailing Address - Street 1:15855 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-6452
Mailing Address - Country:US
Mailing Address - Phone:763-476-8200
Mailing Address - Fax:
Practice Address - Street 1:15855 22ND AVE N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-6452
Practice Address - Country:US
Practice Address - Phone:763-476-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN111740800Medicaid