MEDICARE: FOUNDATION FOR RURAL HEALTH CARE

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	00467	MN

General Provider Information

NPI Number	:	1871589523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATION FOR RURAL HEALTH CARE

Provider Business Mailing Address
First Line	:	905 W 155TH ST
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55306-5405
Country	:	US
Telephone Number	:	952-435-7371
Fax Number	:	952-892-1695

Provider Business Practice Location Address
First Line	:	700 NE RIVERSIDE AVE
Second Line	:
City	:	MCINTOSH
State	:	MN
Zip	:	56556-5700
Country	:	US
Telephone Number	:	218-563-2715
Fax Number	:	218-563-2395

Authorized Official
Title or Position	:	CEO/CFO
Name	:	CORAL BLAZE
Credential	:	RN, C RAC-C
Telephone Number	:	952-435-7371

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	08/22/2020

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Directions to “FOUNDATION FOR RURAL HEALTH CARE ” Practice Location

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