MEDICARE: JUSTIN J TAYLOR

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	310400000X	Assisted Living Facility	394505	MN

General Provider Information

NPI Number	:	1699314765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN J TAYLOR

Provider Business Mailing Address
First Line	:	2020 RIDGEVIEW DR
Second Line	:
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-3829
Country	:	US
Telephone Number	:	218-283-2806
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 RIDGEVIEW DR
Second Line	:
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-3829
Country	:	US
Telephone Number	:	218-283-2806
Fax Number	:	218-283-2177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2020
Last Update Date	:	01/06/2020

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Directions to “ JUSTIN J TAYLOR ” Practice Location

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