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General NPI Number Information
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NPI Number | 1104821891
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Entity Type | Organization
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Legal Business Name | MADONNA TOWERS OF ROCHESTER, INC
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 4001 19TH AVE NW
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City | ROCHESTER
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State | MN
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Zip | 55901-4505
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Country | US
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Telephone | 507-288-3911
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Fax | 507-288-0393
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Provider Business Mailing Address
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Address Line | 4001 19TH AVE NW
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City | ROCHESTER
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State | MN
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Zip | 55901-4505
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Country | US
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Telephone | 507-288-3911
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Fax | 507-288-0393
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Authorized Official
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Title or Position | DIRECTOR, REIMBURSEMENT
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Name | TRICIA L BERGIEN
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Credential |
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Telephone | 612-991-6519
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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 | 328643
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License Number State | MN
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