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Organization
TAMARAC
Active
Organization
TAMARAC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REX CARLSON (TREASURER)
(701) 738-2000
Entity
Organization
Contact information
Practice address
900 LINCOLN AVENUE, STEPHEN, MN 56757
(218) 478-2850
(218) 478-2852
Mailing address
900 LINCOLN AVENUE, STEPHEN, MN 56757
(218) 478-2850
(218) 478-2852
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
329663
MN
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
048165300
—
MN
01
—
329663
ALHCP
MN
01
—
329766
HWS
MN
Enumeration date
05/01/2006
Last updated
08/28/2012
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