MEDICARE: OAKLAND PARK COMMUNITIES, 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	314000000X	Skilled Nursing Facility	335812	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9273 OA	OTHER	MN	BCBS PROVIDER NUMBER
2	NH0431	OTHER	MN	UCARE PROVIDER NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588652259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKLAND PARK COMMUNITIES, INC

Provider Business Mailing Address
First Line	:	123 BAKEN ST
Second Line	:
City	:	THIEF RIVER FALLS
State	:	MN
Zip	:	56701-3903
Country	:	US
Telephone Number	:	218-681-1675
Fax Number	:	218-681-1037

Provider Business Practice Location Address
First Line	:	123 BAKEN ST
Second Line	:
City	:	THIEF RIVER FALLS
State	:	MN
Zip	:	56701-3903
Country	:	US
Telephone Number	:	218-681-1675
Fax Number	:	218-681-1037

Authorized Official
Title or Position	:	ADMINSITRATOR
Name	:	ANGELA MALONE
Credential	:
Telephone Number	:	218-681-1675

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/17/2007

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