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Organization

CHIMNEY PINES LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. PHOUVIENG SIVILAY PS (DIRECTOR/MANAGER)
(612) 508-8743
Entity
Organization

Contact information

Practice address
10452 SPYGLASS DR, EDEN PRAIRIE, MN 55347-4656
(612) 508-8743
Mailing address
10428 SHELTER GRV, EDEN PRAIRIE, MN 55347-4855
(612) 508-8743

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary

Other

Enumeration date
12/11/2023
Last updated
12/11/2023
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