Organization
PHS LAKE MINNETONKA LLC
Active
Other names
Lake Minnetonka Shores
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK MEYER (CFO)
(651) 631-6102
Entity
Organization
Contact information
Practice address
4515 SHORELINE DR, SPRING PARK, MN 55384-8500
(952) 471-4001
(651) 631-6449
Mailing address
4527 SHORELINE DR, SPRING PARK, MN 55384-8706
(952) 471-4001
(651) 631-6449
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172043100
—
MN
01
—
22857
HEALTH PARTNERS
—
01
—
7122641
MEDICA
—
01
—
9625TW
BCBS
—
01
—
NH0041
UCARE
MN
Enumeration date
08/16/2006
Last updated
11/11/2025
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