Healthcare Provider Details

I. General information

NPI: 1467430066
Provider Name (Legal Business Name): WOOD DALE HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SUNRISE BLVD
REDWOOD FALLS MN
56283-1863
US

IV. Provider business mailing address

600 SUNRISE BLVD
REDWOOD FALLS MN
56283-1863
US

V. Phone/Fax

Practice location:
  • Phone: 507-637-3587
  • Fax: 507-637-2546
Mailing address:
  • Phone: 507-637-3587
  • Fax: 507-637-2546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number329922
License Number StateMN

VIII. Authorized Official

Name: MRS. JUDITH A SANDMANN
Title or Position: ADMINISTRATOR
Credential:
Phone: 507-637-3587