1. Home
  2. Directory
  3. Minnesota
  4. Woodbury
  5. Custodial Care Facility
  6. NPI Profile

COLBY LAKE CARE HOME, INC.
NPI 1396980017
Custodial Care Facility - Adult Care Home in Woodbury, MN

Active since December 09, 2008
9377 NEWCASTLE RD, WOODBURY, MN 55125(651) 230-5088 Get Directions Write a Review

NPPES record last updated: December 9, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Colby Lake Care Home, Inc. NPPES

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

COLBY LAKE CARE HOME, INC. (NPI 1396980017) is a healthcare organization registered as an adult care home in Woodbury, Minnesota and active in the NPI registry since December 2008. The organization lists Vijwantie Sirju, Ceo/owner, as its authorized official.

NPPES Registry Identity

NPI1396980017
Entity TypeOrganization
Primary Taxonomy311ZA0620X
Legal Business NameCOLBY LAKE CARE HOME, INC.
Location Address9377 NEWCASTLE RDWoodbury, MN 55125-3717
Mailing Address9377 Newcastle RdWoodbury, MN 55125-3717 · (651) 230-5088
Phone(651) 230-5088
Organization SubpartNo
Authorized OfficialVijwantie SirjuCeo/owner · (651) 230-5088
Enumeration DateDecember 9, 2008
✔ NPI 1396980017 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCustodial Care Facility · Adult Care HomeNursing & Custodial Care Facilities
Taxonomy Code311ZA0620X
License✔ Licensed in MN · 1047414-2-AFC
Definition
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
9377 NEWCASTLE RD, Woodbury, MN 55125
Open in Google Maps ↗

Other Identifiers 1

MedicaidA814673100MN

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 Colby Lake Care Home, Inc.'s NPI number?

The NPI number for Colby Lake Care Home, Inc. is 1396980017. It was assigned to this organization in the NPPES registry on December 9, 2008.

Where is Colby Lake Care Home, Inc. located?

Colby Lake Care Home, Inc. is located at 9377 Newcastle Rd, Woodbury, MN 55125. The listed phone number is (651) 230-5088.

What is Colby Lake Care Home, Inc.'s specialty?

The primary specialty registered for this NPI is Custodial Care Facility, specializing in Adult Care Home, with taxonomy code 311ZA0620X.

When was this NPI record last updated?

The NPPES record for Colby Lake Care Home, Inc. was last updated on December 9, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.