Organization
VOP SOUTH GROVE LODGE, LLC
Active
Other names
South Grove Lodge Senior Living
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERRI LYNN BAKER (DIRECTOR OF LICENSING)
(503) 998-5810
Entity
Organization
Contact information
Practice address
1701 22ND AVE SW, AUSTIN, MN 55912-1798
(507) 396-4960
(507) 434-0041
Mailing address
5101 NE 82ND AVE STE 200, VANCOUVER, WA 98662-6343
(503) 998-5810
(360) 254-1770
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
404147
MINNESOTA DEPARTMENT OF HEALTH (MDH) - ELDERLY WAIVER
MN
Enumeration date
12/08/2021
Last updated
04/01/2026
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