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General NPI Number Information
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NPI Number | 1578578134
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Entity Type | Organization
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Legal Business Name | LYNGBLOMSTEN CARE CENTER, INC.
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 02/08/2010
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Provider Practice Location Address
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Address Line | 1415 ALMOND AVE
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City | SAINT PAUL
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State | MN
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Zip | 55108-2507
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Country | US
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Telephone | 651-632-5310
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Fax | 651-646-8390
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Provider Business Mailing Address
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Address Line | 1415 ALMOND AVE
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City | SAINT PAUL
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State | MN
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Zip | 55108-2507
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Country | US
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Telephone | 651-632-5310
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Fax | 651-646-8390
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Authorized Official
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Title or Position | CFO
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Name | BRADLEY J. JACOBSON
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Credential |
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Telephone | 651-632-5310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 332291
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License Number State | MN
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