| NPI | 1588018071 |
|---|---|
| Doing Business As | MARY MARSHALL RESIDENCE |
| Entity Type | Organization |
| Authorized Contact | NANCY GAVIN Assistant Secretary 952-983-4249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: VA 1104252L155) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2016-04-20 |