| NPI | 1639497340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS TAPEH Owner 651-707-2675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| 3140N1450X Skilled Nursing Facility, Nursing Care, Pediatric | |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities | |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2010-05-06 |