Healthcare Provider Details

I. General information

NPI: 1811442965
Provider Name (Legal Business Name): OAK TERRACE SENIOR HOUSING OF JORDAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 ABERDEEN AVE
JORDAN MN
55352-9516
US

IV. Provider business mailing address

622 ABERDEEN AVE
JORDAN MN
55352-9516
US

V. Phone/Fax

Practice location:
  • Phone: 952-492-5559
  • Fax:
Mailing address:
  • Phone: 952-492-5559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DREW MICHAEL HOOD
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 507-387-2037