| NPI | 1205913613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAISA POVLOVNA KOTULA RN Owner 218-326-6900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: MN 333801) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |