Provider Demographics
NPI:1861721169
Name:METROPOLITAN LIVING, LLC
Entity type:Organization
Organization Name:METROPOLITAN LIVING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LADC, LMFT
Authorized Official - Phone:612-226-7120
Mailing Address - Street 1:2105 W BURNSVILLE PKWY
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4237
Mailing Address - Country:US
Mailing Address - Phone:952-564-3006
Mailing Address - Fax:952-564-3038
Practice Address - Street 1:1400 W 100TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3125
Practice Address - Country:US
Practice Address - Phone:952-881-6424
Practice Address - Fax:952-881-6586
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METROPOLITAN LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-15
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26939310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN346596OtherHOUSING WITH SERVICES
MN345641OtherCLASS F HOME CARE PROVIDER
MN26939OtherMN DEPARTMENT OF HEALTH LICENSE