Healthcare Provider Details

I. General information

NPI: 1144768615
Provider Name (Legal Business Name): ESTATES AT DELANO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

433 COUNTY ROAD 30 SE
DELANO MN
55328-9000
US

IV. Provider business mailing address

638 SOUTHBEND AVE
MANKATO MN
56001-2168
US

V. Phone/Fax

Practice location:
  • Phone: 763-972-2987
  • Fax:
Mailing address:
  • Phone: 507-625-8741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA LEGUM
Title or Position: CEO
Credential:
Phone: 507-625-8741