Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Medicine Lake Manor

Organization Assisted Living Facility · NPI 1104221605

Medicine Lake Manor is an Assisted Living Facility in Plymouth, Minnesota. Licensed in Minnesota. Registered with an NPI since 2014.

Licensed in
MN
In the registry since
2014

Practice location Address checks out

10230 28th Ave N
Plymouth, MN 55441
Phone: (763) 546-4017
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Assisted Living Facility (primary) Taxonomy 310400000X · Licence 370431 (MN)

Record details

NPI number1104221605
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Alla Vaynberg — President/Ceo · (763) 546-4017
NPI enumeratedOctober 27, 2014
Last updated in NPPESOctober 27, 2014
Mailing address10230 28th Ave N, Plymouth, MN 55441-3265

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