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General NPI Number Information
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NPI Number | 1093776395
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Entity Type | Organization
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Legal Business Name | ST. MARKS LUTHERAN HOME
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 400 15TH AVE SW
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City | AUSTIN
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State | MN
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Zip | 55912-3232
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Country | US
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Telephone | 507-437-4594
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Fax | 507-434-7201
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Provider Business Mailing Address
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Address Line | 400 15TH AVE SW
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City | AUSTIN
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State | MN
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Zip | 55912-3232
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Country | US
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Telephone | 507-437-4594
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Fax | 507-434-7201
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | PAULA KAY ROCHELEAU
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Credential |
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Telephone | 320-302-0192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 329304
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 328526
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License Number State | MN
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