Provider Demographics
NPI:1376900365
Name:CANNON FALLS NURSING REHABILITATION, LLC
Entity Type:Organization
Organization Name:CANNON FALLS NURSING REHABILITATION, LLC
Other - Org Name:THE GARDENS AT CANNON FALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EPHRAM
Authorized Official - Middle Name:MORDY
Authorized Official - Last Name:LAHASKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-772-3668
Mailing Address - Street 1:300 DOW ST N
Mailing Address - Street 2:
Mailing Address - City:CANNON FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55009-1810
Mailing Address - Country:US
Mailing Address - Phone:507-263-4658
Mailing Address - Fax:507-263-4127
Practice Address - Street 1:300 DOW ST N
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-1810
Practice Address - Country:US
Practice Address - Phone:507-263-4658
Practice Address - Fax:507-263-4127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility