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General NPI Number Information
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NPI Number | 1437427911
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Entity Type | Organization
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Legal Business Name | FERNBROOK FAMILY CENTER
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 419 BUSH ST
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City | RED WING
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State | MN
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Zip | 55066-2529
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Country | US
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Telephone | 651-212-7429
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 977
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City | OWATONNA
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State | MN
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Zip | 55060-0977
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER/OWNER
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Name | MANDY YOUNG
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Credential |
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Telephone | 507-446-0431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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