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NPI Code Detail

MEDICARE: MINNESOTA ODD FELLOWS HOME

MEDICARE: MINNESOTA ODD FELLOWS HOME
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
1310400000XAssisted Living Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740350792
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINNESOTA ODD FELLOWS HOME
Provider Business Mailing Address
First Line : 815 FOREST AVE
Second Line :
City : NORTHFIELD
State : MN
Zip : 55057-1643
Country : US
Telephone Number : 507-664-8800
Fax Number : 507-645-0942
Provider Business Practice Location Address
First Line : 815 FOREST AVE
Second Line :
City : NORTHFIELD
State : MN
Zip : 55057-1643
Country : US
Telephone Number : 507-664-8800
Fax Number : 507-645-0942
Authorized Official
Title or Position : CFO
Name : CURTIS BACH
Credential :
Telephone Number : 320-589-4910
Provider Enumeration Date : 11/08/2006
Last Update Date : 02/05/2025

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Directions to “MINNESOTA ODD FELLOWS HOME ” Practice Location

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