1. Home
  2. Directory
  3. Minnesota
  4. Plymouth
  5. Assisted Living Facility
  6. NPI Profile

MEDICINE LAKE MANOR
NPI 1104221605
Assisted Living Facility in Plymouth, MN

Active since October 27, 2014
10230 28TH AVE N, PLYMOUTH, MN 55441(763) 546-4017 Get Directions Write a Review

NPPES record last updated: October 27, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Medicine Lake Manor NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MEDICINE LAKE MANOR (NPI 1104221605) is a healthcare organization registered as an assisted living facility in Plymouth, Minnesota and active in the NPI registry since October 2014. The organization lists Alla G Vaynberg, President/ceo, as its authorized official.

NPPES Registry Identity

NPI1104221605
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameMEDICINE LAKE MANOR
Location Address10230 28TH AVE NPlymouth, MN 55441
Mailing Address10230 28th Ave NPlymouth, MN 55441-3265 · (763) 546-4017
Phone(763) 546-4017
Organization SubpartNo
Authorized OfficialAlla G VaynbergPresident/ceo · (763) 546-4017
Enumeration DateOctober 27, 2014
✔ NPI 1104221605 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in MN · 370431
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
10230 28TH AVE N, Plymouth, MN 55441
Open in Google Maps ↗

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VIEWPOINT HEALTHCARE SERVICES LLC
Assisted Living Facility
10230 28TH AVE N
PLYMOUTH, MN 55441
Hennepin County (667) 450-8816
ALLA G. VAYNBERG
Durable Medical Equipment & Medical Supplies
10230 28TH AVE N
PLYMOUTH, MN 55441
Hennepin County (763) 546-4017

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Medicine Lake Manor's NPI number?

The NPI number for Medicine Lake Manor is 1104221605. It was assigned to this organization in the NPPES registry on October 27, 2014.

Where is Medicine Lake Manor located?

Medicine Lake Manor is located at 10230 28th Ave N, Plymouth, MN 55441. The listed phone number is (763) 546-4017.

What is Medicine Lake Manor's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

When was this NPI record last updated?

The NPPES record for Medicine Lake Manor was last updated on October 27, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.