Healthcare Provider Details

I. General information

NPI: 1336359900
Provider Name (Legal Business Name): PRESBYTERIAN FAMILY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 5TH ST N
ATWATER MN
56209
US

IV. Provider business mailing address

901 HIGHWAY 71 NE
WILLMAR MN
56201-2654
US

V. Phone/Fax

Practice location:
  • Phone: 320-974-8070
  • Fax:
Mailing address:
  • Phone: 320-235-5897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 320-235-5897