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Intermediate Care Mental Illness

Morris, Minnesota

Provider NPI: 1164591095

Organization Information:
Organization is Subpart
Authorized Official:  SHERRY  WAGNER  CFO  320-5894902

Practice Location:
Tel: 320-589-3077  Fax: 320-589-2543

Business Mailing Address:
Tel: 320-589-3077  Fax: 320-589-2543

Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Y310500000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mental Illness

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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