Healthcare Provider Details

I. General information

NPI: 1952551293
Provider Name (Legal Business Name): OUR HOUSE OF MURRAY COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 PARK DR
SLAYTON MN
56172-1050
US

IV. Provider business mailing address

36 PARK DR PO BOX 86
SLAYTON MN
56172-1050
US

V. Phone/Fax

Practice location:
  • Phone: 507-836-8114
  • Fax: 507-836-6462
Mailing address:
  • Phone: 507-836-8114
  • Fax: 507-836-6462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number337555
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number219229-4-AFC
License Number StateMN

VIII. Authorized Official

Name: NONA F MAGNUSSEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 507-836-8114