Provider Demographics
NPI:1952719668
Name:COMMUNITY ASSET FOUNDATION, LLC
Entity Type:Organization
Organization Name:COMMUNITY ASSET FOUNDATION, LLC
Other - Org Name:THE LODGE OF HOWARD LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:POKORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-703-5709
Mailing Address - Street 1:445 1ST STREET EAST
Mailing Address - Street 2:
Mailing Address - City:HOWARD LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55349
Mailing Address - Country:US
Mailing Address - Phone:320-543-3331
Mailing Address - Fax:
Practice Address - Street 1:445 1ST STREET EAST
Practice Address - Street 2:
Practice Address - City:HOWARD LAKE
Practice Address - State:MN
Practice Address - Zip Code:55349-5300
Practice Address - Country:US
Practice Address - Phone:320-543-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility