MEDICARE: LIVING SERVICES FOUNDATION/NEW LONDON, 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
1	314000000X	Skilled Nursing Facility	00314	MN

General Provider Information

NPI Number	:	1841288289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING SERVICES FOUNDATION/NEW LONDON, LLC

Provider Business Mailing Address
First Line	:	100 GLENOAKS DR
Second Line	:
City	:	NEW LONDON
State	:	MN
Zip	:	56273-9580
Country	:	US
Telephone Number	:	320-354-2231
Fax Number	:	320-354-2060

Provider Business Practice Location Address
First Line	:	100 GLENOAKS DR
Second Line	:
City	:	NEW LONDON
State	:	MN
Zip	:	56273-9580
Country	:	US
Telephone Number	:	320-354-2231
Fax Number	:	320-354-2060

Authorized Official
Title or Position	:	FINANCIAL SERVICES DIRECTOR
Name	:	MS. KRYSS GIMSE
Credential	:
Telephone Number	:	320-354-6067

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	08/22/2020

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