Healthcare Provider Details

I. General information

NPI: 1255328175
Provider Name (Legal Business Name): FAIRVIEW SEMINARY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 COLLEGE AVE
RED WING MN
55066-2459
US

IV. Provider business mailing address

906 COLLEGE AVE
RED WING MN
55066-2459
US

V. Phone/Fax

Practice location:
  • Phone: 651-385-3434
  • Fax: 651-385-3420
Mailing address:
  • Phone: 651-385-3434
  • Fax: 651-385-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number649240100
License Number StateMN

VIII. Authorized Official

Name: MRS. MARY JO HILL
Title or Position: ADMINISTRATOR
Credential: RN, LNHA
Phone: 651-385-3435