Colby Lake Care Home, Inc.

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

1047414-2-AFC Issued in MN

Legal business name

COLBY LAKE CARE HOME, INC.

Practice address

9377 Newcastle Rd
Woodbury, MN 55125-3717

Phone

(651) 230-5088

NPI assigned

Dec 9, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Vijwantie Sirju, LPN

Title

Ceo/Owner

Phone

(651) 230-5088

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1228780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228780800000",
    "number": "1396980017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9377 NEWCASTLE RD",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551253717",
            "telephone_number": "651-230-5088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9377 NEWCASTLE RD",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551253717",
            "telephone_number": "651-230-5088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLBY LAKE CARE HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-09",
        "last_updated": "2008-12-09",
        "status": "A",
        "authorized_official_last_name": "SIRJU",
        "authorized_official_first_name": "VIJWANTIE",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "651-230-5088",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MN",
            "license": "1047414-2-AFC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A814673100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie M Clausen, APRN
• Krista Cleary, CNM
• Ericka Krystal Michelle Clemons-Rogers
• Brent Cleveland, MD
• Elizabeth Blair Cohen
• Allison Cole, PA-C
• Lenairion Daquan Cole
• Melissa Jean Cole
• Elizabeth Catherine Coleman
• Aixa Mercedes Collazo Fernandez

• Adult Care Home Facility in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Adult Care Home Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2008; 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.