NPI 1003292962

Prior Lake Ops LLC

Organisation Assisted Living Facility Prior Lake, MN

Practice location

Address: 4685 Park Nicollet Ave SE, Prior Lake, MN 55372-3926
Phone: (952) 226-9200
Fax: (952) 226-9201
Mailing address: 7625 Golden Triangle Dr Suite T, Eden Prairie, MN 55344-3710

Authorised official

Name: Ryan Novaczyk
Title: President
Phone: (952) 241-8204

Registered specialties

Assisted Living Facility Primary

Nursing & Custodial Care Facilities Taxonomy 310400000X

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Registry record

NPI: 1003292962
Entity type: Organization
NPI issued: 3 Aug 2015
Record last updated: 3 Aug 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.