Healthcare Provider Details

I. General information

NPI: 1982149241
Provider Name (Legal Business Name): MOORHEAD OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 2ND AVE N
MOORHEAD MN
56560-2511
US

IV. Provider business mailing address

2810 2ND AVE N
MOORHEAD MN
56560-2511
US

V. Phone/Fax

Practice location:
  • Phone: 218-233-7578
  • Fax: 218-233-8307
Mailing address:
  • Phone: 218-233-7578
  • Fax: 218-233-8307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. EPHRAM LAHASKY
Title or Position: PRESIDENT
Credential:
Phone: 646-772-3668