Organization
LSREF GOLDEN OPS 14 (WY) LLC
Active
Other names
Park Place Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
TOM WENTZ JR. (EXEC. VP/COO)
(701) 837-7103
Entity
Organization
Contact information
Practice address
1930 E 12TH ST, CASPER, WY 82601-4075
(307) 265-2273
(307) 265-5384
Mailing address
3015 16TH ST SW, STE 100, MINOT, ND 58701-6906
(701) 837-7103
(701) 838-7785
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
10200
WY
Other
Enumeration date
02/02/2010
Last updated
02/02/2010
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