Healthcare Provider Details

I. General information

NPI: 1306185681
Provider Name (Legal Business Name): NEW JOURNEY RESIDENCE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20371 WENDIGO PARK RD
GRAND RAPIDS MN
55744-4675
US

IV. Provider business mailing address

20371 WENDIGO PARK RD
GRAND RAPIDS MN
55744-4675
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-6900
  • Fax:
Mailing address:
  • Phone: 218-326-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JESSICA RAAD
Title or Position: SECRETARY
Credential:
Phone: 218-326-6900