Provider Demographics
NPI:1194376673
Name:LCS CHAMPLIN LLC
Entity type:Organization
Organization Name:LCS CHAMPLIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:
Authorized Official - First Name:GELYNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-394-2187
Mailing Address - Street 1:119 HAYDEN LAKE RD E
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-1547
Mailing Address - Country:US
Mailing Address - Phone:763-712-0118
Mailing Address - Fax:763-712-0278
Practice Address - Street 1:119 HAYDEN LAKE RD E
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-1547
Practice Address - Country:US
Practice Address - Phone:763-712-0118
Practice Address - Fax:763-712-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility