Organization
WILDWOOD GROVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD A PAYNE (PRESIDENT OF BOARD)
(507) 324-5260
Entity
Organization
Contact information
Practice address
410 E MAIN ST, LE ROY, MN 55951-6731
(507) 324-9515
(507) 324-5355
Mailing address
410 E MAIN ST, LE ROY, MN 55951-6731
(507) 324-9515
(507) 324-5355
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
335745
MN
Other
Enumeration date
05/22/2007
Last updated
08/22/2020
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