Healthcare Provider Details

I. General information

NPI: 1104899939
Provider Name (Legal Business Name): MOTHER OF MERCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 05/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 CHURCH AVENUE
ALBANY MN
56307-0676
US

IV. Provider business mailing address

PO BOX 676
ALBANY MN
56307-0676
US

V. Phone/Fax

Practice location:
  • Phone: 320-845-2195
  • Fax: 320-845-7092
Mailing address:
  • Phone: 320-845-2195
  • Fax: 320-845-7092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number222043100
License Number StateMN

VIII. Authorized Official

Name: MR. DEAN MCDEVITT
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 320-845-2195