NPI | 1003899402 |
---|---|
Entity Type | Organization |
Authorized Contact | JASON E POLOVICK Nursing Home Administrator 218-756-3636 |
Organization Subpart ? | No |
Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MN 328579) |
Additional Taxonomies | 310400000X Assisted Living Facility (Licence: MN 329956) |
Enumeration Date | 2005-11-21 |
Last Update Date | 2011-01-20 |