Tamarac
Organization Active NPI Assisted Living Facility · Stephen, MN
NPI 1053378281 · NPPES record last updated Aug 28, 2012
Key facts
- NPI
- 1053378281
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility 310400000X
- Legal business name
- TAMARAC
- Practice address
- 900 Lincoln Avenue
Stephen, MN 56757 - Phone
- (218) 478-2850
- Fax
- (218) 478-2852
- NPI assigned
- May 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Rex Carlson
- Title
- Treasurer
- Phone
- (701) 738-2000
Corporate family (same tax ID) 1
National Provider Directory
- Tax ID family
- City of Stephen
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 329663 | MN | |
| Assisted Living Facility | 310400000X | Yes |
Addresses
Primary practice location
900 Lincoln Avenue
Stephen, MN 56757
Mailing address
900 Lincoln Avenue
Stephen, MN 56757
Phone (218) 478-2850
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 048165300 | Medicaid | MN | |
| 329766 | Other | MN | HWS |
| 329663 | Other | MN | ALHCP |
Other providers in Stephen, MN
All providers in Stephen, MN · Assisted Living Facility in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.