Organization
BRIDGEWAY ESTATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MERLIN ARTHUR KOESTER (BOARD OF DIRECTORS, PRESIDENT)
(320) 632-9211
Entity
Organization
Contact information
Practice address
103 12TH ST. NE, LITTLE FALLS, MN 56345
(320) 632-2089
(320) 632-2097
Mailing address
103 12TH ST. NE, LITTLE FALLS, MN 56345
(320) 632-2089
(320) 632-2097
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
330186
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4980473
MEDICA
MN
Enumeration date
07/13/2006
Last updated
08/22/2020
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