Organization
OAKRIDGE HOMES OF WADENA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON LEIGH FORBORD CPA (CONTROLLER)
(218) 829-7599
Entity
Organization
Contact information
Practice address
1021 INDUSTRIAL PARK ROAD, BRAINERD, MN 56401-8338
(218) 829-7599
(218) 829-7498
Mailing address
1021 INDUSTRIAL PARK RD SW, BRAINERD, MN 56401-8338
(218) 829-7599
(218) 829-7498
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
151545400
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
066943021
VENDOR NUMBER
MN
01
—
151545400
PROVIDER LICENSE NUMBER
MN
Enumeration date
04/25/2008
Last updated
04/25/2008
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