Provider Demographics
NPI:1346423506
Name:WELLCOME MANOR FAMILY SERVICES
Entity Type:Organization
Organization Name:WELLCOME MANOR FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:GARY
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:507-546-3295
Mailing Address - Street 1:114 WEST PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MN
Mailing Address - Zip Code:56034
Mailing Address - Country:US
Mailing Address - Phone:507-546-3295
Mailing Address - Fax:507-546-3684
Practice Address - Street 1:114 WEST PLEASANT ST.
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MN
Practice Address - Zip Code:56034
Practice Address - Country:US
Practice Address - Phone:507-546-3295
Practice Address - Fax:507-546-3684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0020546324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility