Provider Demographics
NPI:1346436565
Name:SPLIT ROCK OPERATIONS
Entity Type:Organization
Organization Name:SPLIT ROCK OPERATIONS
Other - Org Name:HORIZONS ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVACZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-840-3924
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-0224
Mailing Address - Country:US
Mailing Address - Phone:612-840-3924
Mailing Address - Fax:866-316-6640
Practice Address - Street 1:1909 TALL PINE LN
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-2826
Practice Address - Country:US
Practice Address - Phone:218-391-9199
Practice Address - Fax:218-345-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNPENDING310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility