Provider Demographics
NPI:1114337268
Name:MAHNOMEN AREA ASSISTED LIVING CENTER INC
Entity Type:Organization
Organization Name:MAHNOMEN AREA ASSISTED LIVING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-935-9402
Mailing Address - Street 1:314 WEST JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MAHNOMEN
Mailing Address - State:MN
Mailing Address - Zip Code:56557
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:314 WEST JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MAHNOMEN
Practice Address - State:MN
Practice Address - Zip Code:56557
Practice Address - Country:US
Practice Address - Phone:218-935-2511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN825854503OtherDUNS