# COLBY LAKE CARE HOME, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396980017
- **Authorized official:** MS. VIJWANTIE SIRJU LPN (CEO/OWNER)
- **Authorized official phone:** (651) 230-5088

## Contact information

- **Practice address:** 9377 NEWCASTLE RD, WOODBURY, MN 55125-3717
- **Practice address phone:** (651) 230-5088
- **Mailing address:** 9377 NEWCASTLE RD, WOODBURY, MN 55125-3717
- **Mailing address phone:** (651) 230-5088

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | 1047414-2-AFC | MN | Yes |

## Other

- **Enumeration date:** 12/09/2008
- **Last updated:** 12/09/2008