| NPI | 1346796182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SYLVESTER KOKU AMELETSE Administrator 651-493-3834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2016-08-31 |