Organization
MISSION FARM NURSING HOME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DELBERT CLARK (ADMINISTRATOR)
(763) 559-3123
Entity
Organization
Contact information
Practice address
3401 E MEDICINE LAKE BLVD, PLYMOUTH, MN 55441-2307
(763) 559-3123
(763) 557-9287
Mailing address
3401 E MEDICINE LAKE BLVD, PLYMOUTH, MN 55441-2307
(763) 559-3123
(763) 557-9287
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
331783
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121742900
—
MN
Enumeration date
08/14/2006
Last updated
10/18/2011
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