OrganizationActive
Colby Lake Care Home, Inc.
NPI 1396980017 · Adult Care Home Facility · Woodbury, MN
Provider details
- NPI number
- 1396980017
- Entity type
- Organization
- Primary specialty
- Adult Care Home FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Vijwantie Sirju, Ceo/Owner(651) 230-5088
- License
- 1047414-2-AFC (MN)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Practice location
9377 Newcastle Rd
Woodbury, MN 55125-3717
Phone: (651) 230-5088
Approximate (ZIP-level) locationGet directions
Mailing address
9377 Newcastle Rd
Woodbury, MN 55125-3717
Registry dates
- Enumerated
- 2008-12-09
- Last updated
- 2008-12-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.