Organization
PHS INTERLUDE FRIDLEY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE DONAHUE (CEO/ADMINISTRATOR)
(763) 230-3141
Entity
Organization
Contact information
Practice address
520 OSBORNE RD NE, FRIDLEY, MN 55432-2718
(763) 230-3131
Mailing address
520 OSBORNE RD NE, FRIDLEY, MN 55432-2718
(763) 230-3131
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
07/16/2014
Last updated
12/01/2017
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