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General NPI Number Information
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NPI Number | 1497912224
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Entity Type | Organization
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Legal Business Name | DECKER'S FAMILY CARE, INC.
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 3443 PINE ST.
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City | RANIER
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State | MN
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Zip | 56668
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Country | US
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Telephone | 218-286-5635
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Fax | 218-286-5312
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Provider Business Mailing Address
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Address Line | 3443 PINE STREET
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City | RANIER
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State | MN
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Zip | 56668
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Country | US
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Telephone | 218-286-5635
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Fax | 218-286-5312
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | JOHN ARTHUR DECKER
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Credential | RN
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Telephone | 218-286-5635
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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 | 690956600
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License Number State | MN
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