Provider Demographics
NPI:1316690670
Name:PHS SHOREWOOD LLC
Entity type:Organization
Organization Name:PHS SHOREWOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-631-6120
Mailing Address - Street 1:6000 CHASKA RD
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55331-3189
Mailing Address - Country:US
Mailing Address - Phone:952-401-7444
Mailing Address - Fax:651-631-6122
Practice Address - Street 1:6000 CHASKA RD
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:MN
Practice Address - Zip Code:55331-3189
Practice Address - Country:US
Practice Address - Phone:952-401-7444
Practice Address - Fax:651-631-6122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility