Healthcare Provider Details

I. General information

NPI: 1326042151
Provider Name (Legal Business Name): GOLDEN OAKS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4067 RUNKE RD
HERMANTOWN MN
55811
US

IV. Provider business mailing address

4067 RUNKE RD
HERMANTOWN MN
55811
US

V. Phone/Fax

Practice location:
  • Phone: 218-729-5014
  • Fax: 218-729-0319
Mailing address:
  • Phone: 218-729-5014
  • Fax: 218-729-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number327279
License Number StateMN

VIII. Authorized Official

Name: MRS. LAURA MARIE LOKKEN
Title or Position: DIRECTOR OF NURSING/OWNER
Credential:
Phone: 218-729-5014