Provider Demographics
NPI:1720687411
Name:LASHIA ELDERLY CARE CENTER
Entity Type:Organization
Organization Name:LASHIA ELDERLY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NOM FUE
Authorized Official - Middle Name:
Authorized Official - Last Name:THAO
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:651-379-0005
Mailing Address - Street 1:2355 ARIEL ST N
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2275
Mailing Address - Country:US
Mailing Address - Phone:651-379-0005
Mailing Address - Fax:651-788-7503
Practice Address - Street 1:2355 ARIEL ST N
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2275
Practice Address - Country:US
Practice Address - Phone:651-379-0005
Practice Address - Fax:651-788-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care