| NPI | 1790060838 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER RENEE JOHNSON President/Owner 218-453-5062 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: MN 354457) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: MN 35448) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2011-10-20 |