Healthcare Provider Details

I. General information

NPI: 1275518714
Provider Name (Legal Business Name): MORAVIAN CARE HOUSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 CHERRY DR
WACONIA MN
55387-1405
US

IV. Provider business mailing address

594 CHERRY DR
WACONIA MN
55387-1405
US

V. Phone/Fax

Practice location:
  • Phone: 952-442-2546
  • Fax: 952-442-5504
Mailing address:
  • Phone: 952-442-2546
  • Fax: 952-442-5504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number327649
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number330473
License Number StateMN

VIII. Authorized Official

Name: WAYNE WARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 952-361-0340