Medicine Lake Manor

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

370431 Issued in MN

Legal business name

MEDICINE LAKE MANOR

Practice address

10230 28TH Ave N
Plymouth, MN 55441

Phone

(763) 546-4017

NPI assigned

Oct 27, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Alla G VaynbergNPI 1902039076

Title

President/Ceo

Phone

(763) 546-4017

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alla G. Vaynberg

  • Durable Medical Equipment & Medical Supplies
  • Plymouth, MN
  • NPI 1902039076
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414368000000",
    "number": "1104221605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10230 28TH AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554413265",
            "telephone_number": "763-546-4017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10230 28TH AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "55441",
            "telephone_number": "763-546-4017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICINE LAKE MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-27",
        "last_updated": "2014-10-27",
        "status": "A",
        "authorized_official_last_name": "VAYNBERG",
        "authorized_official_first_name": "ALLA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "763-546-4017",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "370431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Duane Cary McNeil, D.D.S.
• Allison McNulty, DPT
• Jennifer McVann, MS, LMFT
• Lora Meadows
• Medexpress Urgent Care Minnesota, P.C.
• Joshua W Meendering, PSYD
• Allyson Mei, PHARMD
• Alyssa Marie Meier
• Mary Meierbachtol, PT
• Amanda Lynn Melendez

• Assisted Living Facility in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.