COLBY LAKE CARE HOME, INC.
Adult Care Home
Woodbury, Minnesota
Provider NPI: 1396980017
Organization Information:Organization Name: COLBY LAKE CARE HOME, INC.
Practice Location:
9377 NEWCASTLE RD WOODBURY, MN 55125 US
Tel: 651-230-5088 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
9377 NEWCASTLE RD WOODBURY, MN 55125 US
Tel: 651-230-5088 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 311ZA0620X | Nursing & Custodial Care Facilities Custodial Care Facility Adult Care Home | MN | 1047414-2-AFC |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
A814673100 | MN | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin