Organization
COMMUNITY ASSISTED LIVING, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA NOVAK (CEO)
(952) 440-3955
Entity
Organization
Contact information
Practice address
16670 FRANKLIN TRL SE, SUITE 120A, PRIOR LAKE, MN 55372-2924
(952) 440-3955
(952) 440-3956
Mailing address
16670 FRANKLIN TRL SE, SUITE 120A, PRIOR LAKE, MN 55372-2924
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4989251
MEDICA
—
Enumeration date
09/26/2006
Last updated
08/22/2020
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