1154500833 NPI number — FALLS LANDING ASSISTED LIVING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154500833 NPI number — FALLS LANDING ASSISTED LIVING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FALLS LANDING ASSISTED LIVING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154500833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 N HIAWATHA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIPESTONE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56164-2308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-562-6648
Provider Business Mailing Address Fax Number:
507-562-6648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 N HIAWATHA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIPESTONE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56164-2308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-562-6648
Provider Business Practice Location Address Fax Number:
507-562-6648
Provider Enumeration Date:
10/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
507-562-6648

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  334289 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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