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General NPI Number Information
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NPI Number | 1811091036
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Entity Type | Organization
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Legal Business Name | HOLLY RIDGE MANOR
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 500 HOLLY RIDGE DR
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City | STARBUCK
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State | MN
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Zip | 56381-2150
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Country | US
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Telephone | 320-239-4775
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40
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City | STARBUCK
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State | MN
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Zip | 56381-0040
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Country | US
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Telephone | 320-239-7104
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DEBBIE DAWN SCHNEIDER
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Credential |
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Telephone | 320-239-7104
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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 | 333050
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License Number State | MN
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