| NPI | 1164614228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA K LARSON President 218-736-1216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MN 357143200) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2007-08-13 |