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General NPI Number Information
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NPI Number | 1447801303
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Entity Type | Organization
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Legal Business Name | MINNESOTA ODD FELLOWS HOME
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Dates
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Enumeration Date | 09/23/2019
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 815 FOREST AVE
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City | NORTHFIELD
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State | MN
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Zip | 55057-1643
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Country | US
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Telephone | 507-664-8865
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Fax | 507-650-9227
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Provider Business Mailing Address
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Address Line | 815 FOREST AVE
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City | NORTHFIELD
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State | MN
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Zip | 55057-1643
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Country | US
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Telephone | 507-664-8800
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Fax | 507-664-8902
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | CURTIS BACH
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Credential |
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Telephone | 320-589-4942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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