Provider Demographics
NPI:1740855287
Name:ARBOR LAKES SENIOR LIVING II LLC
Entity type:Organization
Organization Name:ARBOR LAKES SENIOR LIVING II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-492-6535
Mailing Address - Street 1:945 SIBLEY MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-2737
Mailing Address - Country:US
Mailing Address - Phone:651-492-6535
Mailing Address - Fax:
Practice Address - Street 1:11955 80TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4755
Practice Address - Country:US
Practice Address - Phone:651-492-6535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility