Healthcare Provider Details

I. General information

NPI: 1649727231
Provider Name (Legal Business Name): OAK TERRACE SENIOR HOUSING OF LE SUEUR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S. 4TH ST.
LE SUEUR MN
56058-2203
US

IV. Provider business mailing address

811 S. 4TH ST.
LE SUEUR MN
56058-2203
US

V. Phone/Fax

Practice location:
  • Phone: 507-593-8500
  • Fax: 507-665-4303
Mailing address:
  • Phone: 507-593-8500
  • Fax: 507-665-4303

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