Healthcare Provider Details

I. General information

NPI: 1295792000
Provider Name (Legal Business Name): FAIRWAY VIEW OF SENIOR COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 LUNDELL AVE
ORTONVILLE MN
56278-4516
US

IV. Provider business mailing address

215 LUNDELL AVE
ORTONVILLE MN
56278-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-888-2923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number328664
License Number StateMN

VIII. Authorized Official

Name: HOWIE GROFF
Title or Position: PRESIDENT
Credential:
Phone: 952-888-2923