| NPI | 1942213954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELBERT CLARK Administrator 763-559-3123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MN 331783) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2011-10-18 |