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General NPI Number Information
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NPI Number | 1912154527
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Entity Type | Organization
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Legal Business Name | WILLMAR COMMONS NURSING & REHABILITATION, INC.
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | 500 RUSSELL ST NW
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City | WILLMAR
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State | MN
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Zip | 56201-2583
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Country | US
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Telephone | 320-235-3181
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Fax |
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Provider Business Mailing Address
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Address Line | 500 RUSSELL ST NW
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City | WILLMAR
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State | MN
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Zip | 56201-2583
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Country | US
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Telephone | 320-235-3181
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. LOWELL P THOMPSON II
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Credential |
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Telephone | 440-937-6201
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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 | 9613190
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License Number State | MN
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