Provider Demographics
NPI:1811509870
Name:AURORA ASSISTED LIVING LLC
Entity type:Organization
Organization Name:AURORA ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:PANG
Authorized Official - Middle Name:
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:651-233-8188
Mailing Address - Street 1:115 MAGNOLIA AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-4916
Mailing Address - Country:US
Mailing Address - Phone:651-233-8188
Mailing Address - Fax:
Practice Address - Street 1:115 MAGNOLIA AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-4916
Practice Address - Country:US
Practice Address - Phone:651-233-8188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility