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General NPI Number Information
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NPI Number | 1649211947
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Entity Type | Organization
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Legal Business Name | JANESVILLE NURSING HOME
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 102 E NORTH ST
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City | JANESVILLE
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State | MN
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Zip | 56048-9793
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Country | US
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Telephone | 507-231-5113
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Fax | 507-231-6310
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Provider Business Mailing Address
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Address Line | 102 E NORTH ST
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City | JANESVILLE
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State | MN
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Zip | 56048-9793
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Country | US
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Telephone | 507-231-5113
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Fax | 507-231-6310
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. R. PETER MADEL III
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Credential |
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Telephone | 507-231-5113
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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 | 331939
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License Number State | MN
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