Organization
PINE RIDGE RESIDENCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD L BLOOFLAT (ADMINISTRATOR)
(218) 694-6716
Entity
Organization
Contact information
Practice address
503 HALLAN AVE, BAGLEY, MN 56621-0029
(218) 694-6716
(218) 694-3799
Mailing address
PO BOX 29, BAGLEY, MN 56621-0029
(218) 694-6716
(218) 694-3799
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
06/18/2007
Last updated
08/22/2020
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