Organization
COUNTY OF DODGE
Active
Other names
FAIRVIEW CARE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY ELLIS NURSING HOME ADMINIS (ADMINISTRATOR)
(507) 635-6401
Entity
Organization
Contact information
Practice address
702 10TH AVE NW, DODGE CENTER, MN 55927-9172
(507) 374-2578
(507) 374-2907
Mailing address
PO BOX 10, 702 - 10TH AVENUE N.W., DODGE CENTER, MN 55927-0010
(507) 374-2578
(507) 374-2907
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
331818
MN
314000000X
Skilled Nursing Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13420100
—
MN
05
—
134240100
—
MN
01
—
9658FA
BLUE CROSS BLUE SHIELD
—
01
—
NH0452
SOUTH COUNTRY HEALTH ALLI
MN
Enumeration date
08/30/2006
Last updated
11/19/2024
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