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General NPI Number Information
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NPI Number | 1104899939
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Entity Type | Organization
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Legal Business Name | MOTHER OF MERCY
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 05/30/2017
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Provider Practice Location Address
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Address Line | 230 CHURCH AVENUE
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City | ALBANY
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State | MN
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Zip | 56307-0676
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Country | US
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Telephone | 320-845-2195
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Fax | 320-845-7092
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Provider Business Mailing Address
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Address Line | PO BOX 676
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City | ALBANY
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State | MN
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Zip | 56307-0676
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Country | US
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Telephone | 320-845-2195
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Fax | 320-845-7092
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | MR. DEAN MCDEVITT
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Credential |
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Telephone | 320-845-2195
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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 | 222043100
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License Number State | MN
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