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NPI Code Detail

MEDICARE: DULUTH NURSING AND REHABILITATION CENTER, LLC

MEDICARE: DULUTH NURSING AND REHABILITATION CENTER, LLC
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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1386006955
Entity Type Code : Organization
Provider Name (Legal Business Name) : DULUTH NURSING AND REHABILITATION CENTER, LLC
Provider Business Mailing Address
First Line : 1601 SAINT LOUIS AVE
Second Line :
City : DULUTH
State : MN
Zip : 55802-2442
Country : US
Telephone Number : 218-727-8651
Fax Number : 218-727-1761
Provider Business Practice Location Address
First Line : 1601 SAINT LOUIS AVE
Second Line :
City : DULUTH
State : MN
Zip : 55802-2442
Country : US
Telephone Number : 218-727-8651
Fax Number : 218-727-1761
Authorized Official
Title or Position : PRESIDENT/MANAGER
Name : MR. EPHRAM MORDY LAHASKY
Credential :
Telephone Number : 646-772-3668
Provider Enumeration Date : 03/23/2016
Last Update Date : 03/23/2016

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