Provider Demographics
NPI:1154584027
Name:GOLDEN OAKS ADVANCED ASSISTED LIVING PLUS - PROCTOR
Entity type:Organization
Organization Name:GOLDEN OAKS ADVANCED ASSISTED LIVING PLUS - PROCTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOKKEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:218-729-5014
Mailing Address - Street 1:4067 REINKE RD
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3611
Mailing Address - Country:US
Mailing Address - Phone:218-729-5014
Mailing Address - Fax:218-729-0319
Practice Address - Street 1:23 WATERVIEW DR
Practice Address - Street 2:
Practice Address - City:PROCTOR
Practice Address - State:MN
Practice Address - Zip Code:55810
Practice Address - Country:US
Practice Address - Phone:218-740-0404
Practice Address - Fax:218-729-0319
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLDEN OAKS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-09
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN339969310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1B1S74GOOtherFIRSTPLAN OF MINNESOTA
MN6080533OtherMEDICA
MN182025OtherUCARE