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Organization

AUGUSTANA DASSEL LAKESIDE COMMUNITY HOME, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SEELOCHANI STADTHERR (DIRECTOR OF REIMBURSEMENT)
(952) 855-5041
Entity
Organization

Contact information

Practice address
439 WILLIAM AVE E, DASSEL, MN 55325-1102
(320) 275-3308
Mailing address
439 WILLIAM AVE E, PO BOX 383, DASSEL, MN 55325-1102
(320) 275-3308

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
335267
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
314182000
MN
Enumeration date
07/18/2007
Last updated
03/13/2020
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