| NPI | 1609011170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENETH NUBIA Administrator 612-309-8391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: MN 340276) |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2008-12-11 |