| NPI | 1356701379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL FILLMORE Owner 952-393-3690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility (Licence: MN 32150) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MN 32150) |
| 315D00000X Hospice, Inpatient (Licence: MN 32150) | |
| Enumeration Date | 2016-03-03 |
| Last Update Date | 2016-03-03 |