MEDICARE: MADONNA MEADOWS

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	310400000X	Assisted Living Facility	326196	MN

General Provider Information

NPI Number	:	1457356149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADONNA MEADOWS

Provider Business Mailing Address
First Line	:	3035 SALEM MEADOWS DR SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55902-2847
Country	:	US
Telephone Number	:	507-252-5400
Fax Number	:	507-252-5500

Provider Business Practice Location Address
First Line	:	3035 SALEM MEADOWS DR SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55902-2847
Country	:	US
Telephone Number	:	507-252-5400
Fax Number	:	507-252-5500

Authorized Official
Title or Position	:	ADMINISTRATOR CEO
Name	:	MR. MARK R CAIRNS
Credential	:
Telephone Number	:	507-288-3911

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	08/22/2020

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