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General NPI Number Information
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NPI Number | 1215255641
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Entity Type | Organization
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Legal Business Name | FREEDOM LIVING CENTER, LLC
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Dates
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Enumeration Date | 05/10/2010
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Last Update Date | 05/10/2010
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Provider Practice Location Address
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Address Line | 306 TOUPIN STREET STE #300
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City | OKLEE
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State | MN
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Zip | 56742
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Country | US
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Telephone | 218-796-5001
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Fax | 218-796-5003
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Provider Business Mailing Address
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Address Line | 306 TOUPIN STREET STE #300
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City | OKLEE
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State | MN
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Zip | 56742
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Country | US
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Telephone | 218-796-5001
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Fax | 218-796-5003
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SUNNY L DORN
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Credential |
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Telephone | 218-796-5001
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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 | 348037
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License Number State | MN
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