| NPI | 1740277391 |
|---|---|
| Doing Business As | EBONY LAKE HEALTH CARE CENTER |
| Entity Type | Organization |
| Authorized Contact | DIANE M RYAN Owner's Representative 952-837-0818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: TX 112530) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2020-08-22 |