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Organization
OAKRIDGE HOMES OF WADENA, INC.
Active
Organization
OAKRIDGE HOMES OF WADENA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON LEIGH FORBORD CPA (CONTROLLER)
(218) 829-7599
Entity
Organization
Contact information
Practice address
1021 INDUSTRIAL PARK ROAD, BRAINERD, MN 56401-8338
(218) 829-7599
(218) 829-7498
Mailing address
1021 INDUSTRIAL PARK RD SW, BRAINERD, MN 56401-8338
(218) 829-7599
(218) 829-7498
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
151545400
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
066943021
VENDOR NUMBER
MN
01
—
151545400
PROVIDER LICENSE NUMBER
MN
Enumeration date
04/25/2008
Last updated
04/25/2008
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