Organization
GREATHOMEMN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GRACIELA AGNE AVILES (RN)
(651) 983-2005
Entity
Organization
Contact information
Practice address
8668 A;LVARADO COURT, INVER GROVE HEIGHTS, MN 55077
(651) 983-2005
Mailing address
8668 A;LVARADO COURT, INVER GROVE HEIGHTS, MN 55077
(651) 983-2005
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
1057918-1-AFC
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4661
GREAT HOME MN
MN
Enumeration date
06/02/2011
Last updated
06/02/2011
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