Healthcare Provider Details

I. General information

NPI: 1457356149
Provider Name (Legal Business Name): MADONNA MEADOWS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 SALEM MEADOWS DR SW
ROCHESTER MN
55902-2847
US

IV. Provider business mailing address

3035 SALEM MEADOWS DR SW
ROCHESTER MN
55902-2847
US

V. Phone/Fax

Practice location:
  • Phone: 507-252-5400
  • Fax: 507-252-5500
Mailing address:
  • Phone: 507-252-5400
  • Fax: 507-252-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number326196
License Number StateMN

VIII. Authorized Official

Name: MR. MARK R CAIRNS
Title or Position: ADMINISTRATOR CEO
Credential:
Phone: 507-288-3911