Provider Demographics
NPI:1982790374
Name:GONDOLA GROUP
Entity Type:Organization
Organization Name:GONDOLA GROUP
Other - Org Name:GONDOLA GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:
Authorized Official - Last Name:SALBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-457-3619
Mailing Address - Street 1:19113 INMAN CT
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-4702
Mailing Address - Country:US
Mailing Address - Phone:952-457-3619
Mailing Address - Fax:
Practice Address - Street 1:8615 BIRCH BLVD
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-5141
Practice Address - Country:US
Practice Address - Phone:651-451-0339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN334062310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility