Healthcare Provider Details

I. General information

NPI: 1013919901
Provider Name (Legal Business Name): ORTONVILLE AREA HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 EASTVOLD AVE
ORTONVILLE MN
56278-1252
US

IV. Provider business mailing address

450 EASTVOLD AVE
ORTONVILLE MN
56278-1252
US

V. Phone/Fax

Practice location:
  • Phone: 320-839-2502
  • Fax: 320-839-4105
Mailing address:
  • Phone: 320-839-2502
  • Fax: 320-839-4105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number359229
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number328367
License Number StateMN

VIII. Authorized Official

Name: MR. DAVID ROGERS
Title or Position: ADMINISTRATOR
Credential:
Phone: 320-839-2502