Provider Demographics
NPI:1154454528
Name:MAY CREEK LODGE INC.
Entity Type:Organization
Organization Name:MAY CREEK LODGE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-547-4515
Mailing Address - Street 1:PO BOX 530
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MN
Mailing Address - Zip Code:56484-0530
Mailing Address - Country:US
Mailing Address - Phone:218-547-4515
Mailing Address - Fax:218-547-7553
Practice Address - Street 1:303 10TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MN
Practice Address - Zip Code:56484-0530
Practice Address - Country:US
Practice Address - Phone:218-547-4515
Practice Address - Fax:218-547-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNFBL-0017382-19848310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility