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General NPI Number Information
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NPI Number | 1326377979
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Entity Type | Organization
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Legal Business Name | BUFFALO LAKE HEALTHCARE CENTER INC.
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 12/10/2009
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Provider Practice Location Address
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Address Line | 703 W YELLOWSTONE TRL
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City | BUFFALO LAKE
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State | MN
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Zip | 55314-1042
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Country | US
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Telephone | 320-833-5364
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Fax | 320-833-5526
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Provider Business Mailing Address
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Address Line | PO BOX 368
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City | BUFFALO LAKE
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State | MN
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Zip | 55314-0368
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Country | US
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Telephone | 320-833-5364
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Fax | 320-833-5526
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARK RUST
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Credential |
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Telephone | 320-833-5364
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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 | 346725
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License Number State | MN
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