Healthcare Provider Details

I. General information

NPI: 1588652259
Provider Name (Legal Business Name): OAKLAND PARK COMMUNITIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 BAKEN ST
THIEF RIVER FALLS MN
56701-3903
US

IV. Provider business mailing address

123 BAKEN ST
THIEF RIVER FALLS MN
56701-3903
US

V. Phone/Fax

Practice location:
  • Phone: 218-681-1675
  • Fax: 218-681-1037
Mailing address:
  • Phone: 218-681-1675
  • Fax: 218-681-1037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number335812
License Number StateMN

VIII. Authorized Official

Name: ANGELA MALONE
Title or Position: ADMINSITRATOR
Credential:
Phone: 218-681-1675