Organization
MEDICINE LAKE MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALLA G VAYNBERG (PRESIDENT/CEO)
(763) 546-4017
Entity
Organization
Contact information
Practice address
10230 28TH AVE N, PLYMOUTH, MN 55441
(763) 546-4017
Mailing address
10230 28TH AVE N, PLYMOUTH, MN 55441-3265
(763) 546-4017
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
370431
MN
Other
Enumeration date
10/27/2014
Last updated
10/27/2014
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