Organization
SHOLOM COMMUNITY ALLIANCE, LLC
Active
Other names
Roitenberg Family Assisted Living Residence
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS WYCKOFF (CONTROLLER)
(952) 939-1637
Entity
Organization
Contact information
Practice address
3610 PHILLIPS PKWY, ST LOUIS PARK, MN 55426-3765
(952) 908-1700
Mailing address
3610 PHILLIPS PKWY, ST LOUIS PARK, MN 55426-3765
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
05/14/2019
Last updated
05/14/2019
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