MEDICARE: ROBBINSDALE REHAB AND CARE CTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1134357569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBBINSDALE REHAB AND CARE CTR

Provider Business Mailing Address
First Line	:	3130 GRIMES AVE N
Second Line	:
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-3217
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 GRIMES AVENUE NORTH
Second Line	:
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422
Country	:	US
Telephone Number	:	736-450-2737
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL DIR OF REHAB
Name	:	LISABETH MACKALL
Credential	:
Telephone Number	:	612-437-0213

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	06/24/2009

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