OrganizationActive
Medicine Lake Manor
NPI 1104221605 · Assisted Living Facility · Plymouth, MN
Medicine Lake Manor is a Assisted Living Facility organization in Plymouth, MN (NPI 1104221605).
Provider details
- NPI number
- 1104221605
- Entity type
- Organization
- Primary specialty
- Assisted Living FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Alla Vaynberg, President/Ceo(763) 546-4017
- License
- 370431 (MN)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Detailed profile(75/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
10230 28th Ave N
Plymouth, MN 55441
Phone: (763) 546-4017
Street-level locationGet directions
Mailing address
10230 28th Ave N
Plymouth, MN 55441-3265
Registry dates
- Enumerated
- 2014-10-27
- Last updated
- 2014-10-27
Frequently asked questions
- What is Medicine Lake Manor's NPI number?
- Medicine Lake Manor's National Provider Identifier (NPI) is 1104221605, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Medicine Lake Manor?
- Medicine Lake Manor is classified in the NPPES registry as Assisted Living Facility (Nursing & Custodial Care Facilities).
- Where is Medicine Lake Manor located?
- Medicine Lake Manor's practice location on file with NPPES is 10230 28th Ave N, Plymouth, MN 55441.
- What is Medicine Lake Manor's phone number?
- The practice phone number listed in the NPPES registry for Medicine Lake Manor is (763) 546-4017.
- Who is the authorized official for Medicine Lake Manor?
- The authorized official listed on Medicine Lake Manor's NPPES record is Alla Vaynberg, President/Ceo. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Medicine Lake Manor's NPI active?
- Yes — Medicine Lake Manor's NPI (1104221605) is active in the NPPES registry as of the last update on 2014-10-27.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.