Organization
FAIRFAX COMMUNITY HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUDITH A SANDMANN (ADMINISTRATOR)
(507) 426-8241
Entity
Organization
Contact information
Practice address
300 10TH AVE SE, FAIRFAX, MN 55332-2149
(507) 426-8241
(507) 426-7340
Mailing address
300 10TH AVE SE, FAIRFAX, MN 55332-2149
(507) 426-8241
(507) 426-7340
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
328593
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030802015
PRIME WEST HEALTH SYSTEM
MN
05
—
138740500
—
MN
01
—
7122754
MEDICA
—
01
—
8669FA
BLUE CROSS BLUE SHIELD
MN
Enumeration date
12/16/2005
Last updated
05/08/2013
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