Organization
OUR HOMES SOUTH, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNIS KLAUS BURGESS (CHIEF EXECUTIVE OFFICER)
(507) 455-2114
Entity
Organization
Contact information
Practice address
113 NORTH MAIN STREET, MEDFORD, MN 55049-0119
(507) 455-2114
(507) 455-2178
Mailing address
PO BOX 119, MEDFORD, MN 55049-0119
(507) 455-2114
(507) 455-2178
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
8065272WS
MN
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
8092892WS
MN
Other
Enumeration date
10/18/2006
Last updated
08/22/2020
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