Basic Information
| Provider Information | |||||||||
| NPI: | 1437151610 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEYVIEW MANOR NURSING HOME | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 9TH AVE E | ||||||||
| Address2: | |||||||||
| City: | LAMBERTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 561521024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5077527346 | ||||||||
| FaxNumber: | 5077527348 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 9TH AVE E | ||||||||
| Address2: | |||||||||
| City: | LAMBERTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 561521024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5077527346 | ||||||||
| FaxNumber: | 5077527348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 07/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | GROFF | ||||||||
| AuthorizedOfficialFirstName: | HOWIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9528882923 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 326611 | MN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 425340000 | 05 | MN | MEDICAID |