1649212986 NPI number — MONTE VISTA LODGE LIMITED PARTNERSHIP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649212986 NPI number — MONTE VISTA LODGE LIMITED PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTE VISTA LODGE LIMITED PARTNERSHIP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649212986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1107 HAZELTINE BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CHASKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55318-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-361-8000
Provider Business Mailing Address Fax Number:
952-361-8058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2211 MASSACHUSETTS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEMON GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91945-3616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-465-1331
Provider Business Practice Location Address Fax Number:
619-465-2426
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOODMAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT OF GENERAL PARTNER
Authorized Official Telephone Number:
952-361-8000

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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