1952551293 NPI number — OUR HOUSE OF MURRAY COUNTY

Table of content: (NPI 1952551293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952551293 NPI number — OUR HOUSE OF MURRAY COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUR HOUSE OF MURRAY COUNTY
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:
1952551293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 PARK DR
Provider Second Line Business Mailing Address:
PO BOX 86
Provider Business Mailing Address City Name:
SLAYTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56172-1050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-836-8114
Provider Business Mailing Address Fax Number:
507-836-6462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLAYTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56172-1050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-836-8114
Provider Business Practice Location Address Fax Number:
507-836-6462
Provider Enumeration Date:
09/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MAGNUSSEN
Authorized Official First Name:
NONA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
507-836-8114

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  337555 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253J00000X , with the licence number: 219229-4-AFC , 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)

  • Identifier: 240897000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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