Organization
LAKEVIEW RESIDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAY WALL (OWNER)
(218) 741-8996
Entity
Organization
Contact information
Practice address
201 N 6TH AVE, VIRGINIA, MN 55792-2437
(218) 741-8996
Mailing address
PO BOX 1267, VIRGINIA, MN 55792-1267
(218) 741-8996
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
MN
Other
Enumeration date
04/20/2007
Last updated
08/22/2020
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