Healthcare Provider Details

I. General information

NPI: 1770676637
Provider Name (Legal Business Name): BIG STONE COMMUNITY HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BURDICK AVE
ORTONVILLE MN
56278-1167
US

IV. Provider business mailing address

501 BURDICK AVE
ORTONVILLE MN
56278-1167
US

V. Phone/Fax

Practice location:
  • Phone: 320-839-6139
  • Fax: 320-839-2060
Mailing address:
  • Phone: 320-839-6139
  • Fax: 320-839-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number801570-1-RS
License Number StateMN

VIII. Authorized Official

Name: MRS. KRISTEN ANN UNRUH
Title or Position: ADMINISTRATOR
Credential:
Phone: 320-839-6139