# VOP SOUTH GROVE LODGE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** South Grove Lodge Senior Living
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295494110
- **Authorized official:** MS. TERRI LYNN BAKER (DIRECTOR OF LICENSING)
- **Authorized official phone:** (503) 998-5810

## Contact information

- **Practice address:** 1701 22ND AVE SW, AUSTIN, MN 55912-1798
- **Practice address phone:** (507) 396-4960
- **Practice address fax:** (507) 434-0041
- **Mailing address:** 5101 NE 82ND AVE STE 200, VANCOUVER, WA 98662-6343
- **Mailing address phone:** (503) 998-5810
- **Mailing address fax:** (360) 254-1770

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 12/08/2021
- **Last updated:** 04/01/2026