Healthcare Provider Details

I. General information

NPI: 1053360602
Provider Name (Legal Business Name): ZUMBROTA HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 W 4TH ST
ZUMBROTA MN
55992-1252
US

IV. Provider business mailing address

801 NEVADA AVE
MORRIS MN
56267-1865
US

V. Phone/Fax

Practice location:
  • Phone: 507-732-8400
  • Fax: 507-732-8430
Mailing address:
  • Phone: 320-589-2004
  • Fax: 320-589-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number331870
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number329634
License Number StateMN

VIII. Authorized Official

Name: SHERRY WAGNER
Title or Position: CFO
Credential:
Phone: 320-589-4902