Provider Demographics
NPI:1740887090
Name:PRAIRIE BLUFFS SENIOR LIVING OPERATIONS LLC
Entity type:Organization
Organization Name:PRAIRIE BLUFFS SENIOR LIVING OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-706-2715
Mailing Address - Street 1:820 LILAC DR N STE 170
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-0700
Mailing Address - Country:US
Mailing Address - Phone:651-706-2715
Mailing Address - Fax:
Practice Address - Street 1:10300 HENNEPIN TOWN RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-5100
Practice Address - Country:US
Practice Address - Phone:952-444-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility