Organization
HAVEN MANOR
Active
Other names
BARRETT PRODY
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY A BELLMORE (MANAGER)
(218) 739-2799
Entity
Organization
Contact information
Practice address
419 E SAINT CHARLES AVE, FERGUS FALLS, MN 56537-3616
(218) 739-2799
Mailing address
419 E SAINT CHARLES AVE, FERGUS FALLS, MN 56537-3616
(218) 739-2799
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
1058161-1-AFC
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1058161-1-AFC
MINNESOTA LICENSE
MN
Enumeration date
08/04/2010
Last updated
08/04/2010
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