Healthcare Provider Details

I. General information

NPI: 1285073783
Provider Name (Legal Business Name): BROOKE MANOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4878 HWY 31
BROOKSTON MN
55711
US

IV. Provider business mailing address

4660 AUNE RD
SAGINAW MN
55779-9682
US

V. Phone/Fax

Practice location:
  • Phone: 218-453-5262
  • Fax: 218-453-1023
Mailing address:
  • Phone: 218-453-5262
  • Fax: 218-453-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number362531
License Number StateMN

VIII. Authorized Official

Name: VIRGINIA TUOMINEN
Title or Position: PRESIDENT
Credential:
Phone: 218-590-7322