Provider Demographics
NPI:1255328175
Name:FAIRVIEW SEMINARY HOME
Entity Type:Organization
Organization Name:FAIRVIEW SEMINARY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LNHA
Authorized Official - Phone:651-385-3435
Mailing Address - Street 1:906 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2459
Mailing Address - Country:US
Mailing Address - Phone:651-385-3434
Mailing Address - Fax:651-385-3420
Practice Address - Street 1:906 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2459
Practice Address - Country:US
Practice Address - Phone:651-385-3434
Practice Address - Fax:651-385-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN649240100314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245449BMedicare Oscar/Certification