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General NPI Number Information
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NPI Number | 1033116629
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Entity Type | Organization
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Legal Business Name | INFINIA AT WILLMAR
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 RUSSELL ST
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City | WILLMAR
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State | MN
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Zip | 56201-2583
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Country | US
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Telephone | 320-235-3181
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Fax | 320-235-0113
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Provider Business Mailing Address
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Address Line | 500 RUSSELL ST
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City | WILLMAR
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State | MN
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Zip | 56201-2583
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Country | US
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Telephone | 320-235-3181
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Fax | 320-235-0113
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT ROBERTSON
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Credential |
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Telephone | 801-295-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 313475
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License Number State | MN
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