Organization
ROSE HAVEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL EDWAED HENDRICKSON (OWNER)
(218) 564-4268
Entity
Organization
Contact information
Practice address
37 6TH ST SE, MENAHGA, MN 56464-3157
(218) 564-4268
(218) 564-5449
Mailing address
37 6TH ST SE, MENAHGA, MN 56464-3157
(218) 564-4268
(218) 564-5449
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
311500000X
Alzheimer Center (Dementia Center)
—
—
315D00000X
Inpatient Hospice
—
—
Other
Enumeration date
03/12/2013
Last updated
03/12/2013
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