Organization
FOUNDATION FOR RURAL HEALTH CARE
Active
Other names
Crestview Manor
Organization subpart
No
Provider details
NPI number
Authorized official
CORAL BLAZE RN,C RAC-C (CEO/CFO)
(952) 435-7371
Entity
Organization
Contact information
Practice address
649 STATE ST NW, EVANSVILLE, MN 56326-8124
(218) 948-2219
(218) 948-2004
Mailing address
905 W 155TH ST, BURNSVILLE, MN 55306-5405
(952) 435-7371
(952) 892-1695
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
00110
MN
Other
Enumeration date
09/27/2005
Last updated
08/22/2020
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