Organization
GAYLORD LAKEVIEW HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY NELL ZELLNER (ADMINISTRATOR)
(507) 237-2911
Entity
Organization
Contact information
Practice address
640 3RD ST, GAYLORD, MN 55334-2297
(507) 237-2911
(507) 237-5744
Mailing address
640 3RD ST, GAYLORD, MN 55334-2297
(507) 237-2911
(507) 237-5744
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
318160
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71-22555
MEDICA
MN
01
—
9711LA
BLUE CROSS BLUE SHIELD
MN
Enumeration date
06/28/2005
Last updated
07/16/2007
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