| NPI | 1760469878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE R PETERSON Administrator 218-644-3331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: MN 330912) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2020-08-22 |