Healthcare Provider Details

I. General information

NPI: 1730352204
Provider Name (Legal Business Name): STATE OPERATED FORENSIC NURSING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FREEMAN DR
SAINT PETER MN
56082-3504
US

IV. Provider business mailing address

100 FREEMAN DR
SAINT PETER MN
56082-3504
US

V. Phone/Fax

Practice location:
  • Phone: 507-931-7166
  • Fax: 507-931-7275
Mailing address:
  • Phone: 507-931-7166
  • Fax: 507-931-7275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number339700
License Number StateMN

VIII. Authorized Official

Name: MRS. MICHELLE BORDEN CHALIN
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 507-931-7166