Provider Demographics
NPI:1124880786
Name:MEADOWOOD SENIOR LIVING LLC
Entity type:Organization
Organization Name:MEADOWOOD SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-248-5368
Mailing Address - Street 1:945 SIBLEY MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LILYDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55118-2737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6555 LOFTUS LN
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-5532
Practice Address - Country:US
Practice Address - Phone:651-888-9724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility