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Organization
HENRY HAGEN RESIDENCE
Active
Organization
HENRY HAGEN RESIDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER DAVID REYNOLDS (OWNER)
(651) 603-8881
Entity
Organization
Contact information
Practice address
19845 LILLEHEI AVE, HASTINGS, MN 55033-9354
(651) 437-9363
(651) 437-9363
Mailing address
19845 LILLEHEI AVE, HASTINGS, MN 55033-9354
(651) 437-9363
(651) 437-9363
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
01091
MN
Other
Enumeration date
01/14/2008
Last updated
01/14/2008
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