Organization
LAKE RIDGE CARE CENTER OF BUFFALO, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SEELOCHANI STADTHERR (SENIOR DIRECTOR OF REIMBURSEMENT)
(952) 855-5041
Entity
Organization
Contact information
Practice address
310 LAKE BLVD S, BUFFALO, MN 55313-1456
(763) 682-1434
(763) 682-6419
Mailing address
310 LAKE BLVD S, BUFFALO, MN 55313-1456
(763) 682-1434
(763) 682-6419
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
327290
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
066663700
—
MN
01
—
327290
MINNESOTA STATE LICENSE
MN
Enumeration date
10/07/2005
Last updated
04/06/2023
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