MEDICARE: FAULKNER AND REYNOLDS ENTERPRISES, INC

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	313M00000X	Nursing Facility/Intermediate Care Facility	327672	MN
2	313M00000X	Nursing Facility/Intermediate Care Facility	360749	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	:	1538140496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAULKNER AND REYNOLDS ENTERPRISES, INC

Provider Business Mailing Address
First Line	:	1620 RANDOLPH AVE
Second Line	:
City	:	ST. PAUL
State	:	MN
Zip	:	55105
Country	:	US
Telephone Number	:	651-690-4458
Fax Number	:	651-690-2787

Provider Business Practice Location Address
First Line	:	1620 RANDOLPH AVE
Second Line	:
City	:	ST. PAUL
State	:	MN
Zip	:	55105
Country	:	US
Telephone Number	:	651-690-4458
Fax Number	:	651-690-2787

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER
Name	:	LAURA REYNOLDS
Credential	:	ADMINISTRATOR
Telephone Number	:	651-690-4458

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	02/12/2013

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Directions to “FAULKNER AND REYNOLDS ENTERPRISES, INC ” Practice Location

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