MEDICARE: MCINTOSH SENIOR LIVING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311500000X	Alzheimer Center (Dementia Center)	346410	MN
2	314000000X	Skilled Nursing Facility	346410	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033443858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCINTOSH SENIOR LIVING

Provider Business Mailing Address
First Line	:	600 RIVERSIDE AVE NE
Second Line	:
City	:	MCINTOSH
State	:	MN
Zip	:	56556-5750
Country	:	US
Telephone Number	:	218-563-2715
Fax Number	:	218-563-2395

Provider Business Practice Location Address
First Line	:	600 RIVERSIDE AVE NE
Second Line	:
City	:	MCINTOSH
State	:	MN
Zip	:	56556-5750
Country	:	US
Telephone Number	:	218-563-2715
Fax Number	:	218-563-2395

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SHARLENE KNUTSON
Credential	:
Telephone Number	:	218-563-2715

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	10/15/2019

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Directions to “MCINTOSH SENIOR LIVING ” Practice Location

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