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Organization

HENRY HAGEN RESIDENCE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ROGER DAVID REYNOLDS (OWNER)
(651) 603-8881
Entity
Organization

Contact information

Practice address
19845 LILLEHEI AVE, HASTINGS, MN 55033-9354
(651) 437-9363
(651) 437-9363
Mailing address
19845 LILLEHEI AVE, HASTINGS, MN 55033-9354
(651) 437-9363
(651) 437-9363

Taxonomy

Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
01091
MN

Other

Enumeration date
01/14/2008
Last updated
01/14/2008
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