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General NPI Number Information
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NPI Number | 1124103569
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Entity Type | Organization
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Legal Business Name | COUNTRY MEADOWS OF MILACA, INC.
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 740 2ND ST. SE
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City | MILACA
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State | MN
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Zip | 56353-0157
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Country | US
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Telephone | 320-983-2185
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Fax | 320-983-2190
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Provider Business Mailing Address
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Address Line | 7171 OHMS LN
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City | EDINA
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State | MN
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Zip | 55439-2142
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Country | US
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Telephone | 952-855-5041
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE VP OF REVENUE CYCLE MGMT
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Name | SEELOCHANI STADTHERR
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Credential |
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Telephone | 952-855-5041
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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 | 332815
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License Number State | MN
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