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Organization
VSSA BOUTWELLS LANDING, LLC
Active
Organization
VSSA BOUTWELLS LANDING, LLC
Active
Other names
Boutwells Landing, BOUTWELLS LANDING
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN DAVID TRANBY (PAYER RELATIONS DIRECTOR)
(651) 631-6102
Entity
Organization
Contact information
Practice address
5600 NORWICH PKWY, OAK PARK HEIGHTS, MN 55082-6482
(651) 430-7202
(651) 430-7201
Mailing address
2845 HAMLINE AVE N, ROSEVILLE, MN 55113
(651) 631-6102
(651) 746-2752
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
359577
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A926608200
UMPI
MN
Enumeration date
03/12/2014
Last updated
09/03/2026
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