Organization
CITY OF ULEN & MUNICIPAL LIQUOR STORE & VIKING MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TODD M KJOS (ADMINISTRATOR)
(218) 596-8847
Entity
Organization
Contact information
Practice address
317 1ST ST NW, ULEN, MN 56585
(218) 596-8847
(218) 596-8894
Mailing address
317 1ST STREET NW, ULEN, MN 56585
(218) 596-8847
(218) 596-8894
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
331816
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4699VI
BLUE CROSS BLUE SHIELD
MN
01
—
7122755
MEDICA
MN
05
—
734040100
—
MN
Enumeration date
12/28/2006
Last updated
09/09/2009
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