| NPI | 1992782221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS WYCKOFF Controller 952-939-1637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MN 328527) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2019-05-14 |