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General NPI Number Information
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NPI Number | 1649603432
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Entity Type | Organization
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Legal Business Name | CONNIE LOBERGS ADULT FOSTER CARE HOME
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Dates
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Enumeration Date | 08/15/2013
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 13038 EXECUTIVE ACRES RD
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City | BRAINERD
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State | MN
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Zip | 56401-5264
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Country | US
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Telephone | 218-825-8502
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Fax |
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Provider Business Mailing Address
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Address Line | 13038 EXECUTIVE ACRES RD
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City | BRAINERD
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State | MN
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Zip | 56401-5264
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Country | US
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Telephone | 218-825-8502
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Fax |
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Authorized Official
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Title or Position | LICENSED ADULT FOSTER CARE HOME
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Name | MRS. CONNIE J LOBERG
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Credential |
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Telephone | 218-825-8502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 8086862AFC
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License Number State | MN
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