Organization
WENDIGO PINES ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAISA POVLOVNA KOTULA RN (RN OWNER)
(218) 326-6900
Entity
Organization
Contact information
Practice address
20371 WENDIGO PARK RD, GRAND RAPIDS, MN 55744
(218) 326-6900
(218) 326-6900
Mailing address
20371 WENDIGO PARK RD, GRAND RAPIDS, MN 55744
(218) 326-6900
(218) 326-6900
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
333801
MN
Other
Enumeration date
11/01/2006
Last updated
08/22/2020
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