Healthcare Provider Details

I. General information

NPI: 1912154527
Provider Name (Legal Business Name): WILLMAR COMMONS NURSING & REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUSSELL ST NW
WILLMAR MN
56201-2583
US

IV. Provider business mailing address

500 RUSSELL ST NW
WILLMAR MN
56201-2583
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-3181
  • Fax:
Mailing address:
  • Phone: 320-235-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number9613190
License Number StateMN

VIII. Authorized Official

Name: MR. LOWELL P THOMPSON II
Title or Position: CEO
Credential:
Phone: 440-937-6201