| NPI | 1003893447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN DOUGHTY Administrator 507-442-7121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Additional Taxonomies | 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2012-12-28 |