Healthcare Provider Details

I. General information

NPI: 1114337268
Provider Name (Legal Business Name): MAHNOMEN AREA ASSISTED LIVING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 WEST JEFFERSON AVE
MAHNOMEN MN
56557
US

IV. Provider business mailing address

314 WEST JEFFERSON AVE
MAHNOMEN MN
56557
US

V. Phone/Fax

Practice location:
  • Phone: 218-935-2511
  • Fax:
Mailing address:
  • Phone:
  • 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: SUSAN KLASSEN
Title or Position: CEO
Credential:
Phone: 218-935-9402