Organization
BUFFALO LAKE HEALTHCARE CENTER INC,.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK RUST (ADMINISTRATOR)
(320) 833-5364
Entity
Organization
Contact information
Practice address
703 W YELLOWSTONE TRL, BUFFALO LAKE, MN 55314-1042
(320) 833-5364
(320) 833-5526
Mailing address
703 W YELLOWSTONE TRL, P.O. BOX 368, BUFFALO LAKE, MN 55314-1042
(320) 833-5364
(320) 833-5526
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
550
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
090243800
—
MN
05
—
550
—
MN
01
—
8461BU
BLUE CROSS BLUE SHIELD
MN
Enumeration date
06/10/2006
Last updated
12/11/2013
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