Provider Demographics
NPI:1043486210
Name:CLADDAGH HOUSE, INC.
Entity Type:Organization
Organization Name:CLADDAGH HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDEBUHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-896-2213
Mailing Address - Street 1:10431 MOUND PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MN
Mailing Address - Zip Code:55943-7223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 S 2ND ST
Practice Address - Street 2:
Practice Address - City:LA CRESCENT
Practice Address - State:MN
Practice Address - Zip Code:55947-1372
Practice Address - Country:US
Practice Address - Phone:507-895-6447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home