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General NPI Number Information
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NPI Number | 1891798823
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Entity Type | Organization
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Legal Business Name | MONTICELLO BIG LAKE HOSPITAL NURSING HOME
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1013 HART BLVD
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City | MONTICELLO
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State | MN
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Zip | 55362-8575
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Country | US
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Telephone | 763-295-2945
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Fax | 763-271-2421
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Provider Business Mailing Address
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Address Line | 1013 HART BLVD
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City | MONTICELLO
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State | MN
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Zip | 55362-8575
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Country | US
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Telephone | 763-295-2945
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Fax | 763-271-2421
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Authorized Official
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Title or Position | BUSINESS OFFICE SUPERVISOR
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Name | MRS. SANDRA R PAWELK
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Credential |
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Telephone | 763-271-2306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 328129
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License Number State | MN
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