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General NPI Number Information
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NPI Number | 1083880488
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Entity Type | Organization
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Legal Business Name | BEAR CREEK SERVICES
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 3108 HWY 52 N
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City | ROCHESTER
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State | MN
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Zip | 55901-1916
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Country | US
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Telephone | 507-288-7195
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Fax |
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Provider Business Mailing Address
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Address Line | 3108 HWY 52 N
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City | ROCHESTER
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State | MN
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Zip | 55901-1916
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | DIANE SELLNER
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Credential |
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Telephone | 507-288-7195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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