| NPI | 1932196235 |
|---|---|
| Other Name | GRAND AVENUE RESIDENCE |
| Entity Type | Organization |
| Authorized Contact | NANCY LYNN SODERBECK Acting Administrator 612-824-1434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness |
| Enumeration Date | 2005-10-01 |
| Last Update Date | 2020-08-22 |