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General NPI Number Information
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NPI Number | 1851895809
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Entity Type | Organization
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Legal Business Name | HINCKLEY ASSISTED LIVING LLC.
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 03/22/2018
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Provider Practice Location Address
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Address Line | 710 SPRING LN
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City | HINCKLEY
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State | MN
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Zip | 55037-8362
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Country | US
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Telephone | 320-384-7373
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Fax | 320-384-0700
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Provider Business Mailing Address
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Address Line | 710 SPRING LN
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City | HINCKLEY
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State | MN
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Zip | 55037-8362
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Country | US
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Telephone | 320-384-7373
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Fax | 320-384-0700
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | RONALD AUSMUS
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Credential |
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Telephone | 320-224-8357
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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 | 385020
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License Number State | MN
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