Provider Demographics
NPI:1508134727
Name:MARY GARGANO ADULT FOSTER CARE
Entity Type:Organization
Organization Name:MARY GARGANO ADULT FOSTER CARE
Other - Org Name:GARGANO ADULT FOST CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADULT FOSTER CARE (MARY GARGANO'S)
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARGANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-778-6370
Mailing Address - Street 1:12689 OLD HIGHWAY 169
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-8322
Mailing Address - Country:US
Mailing Address - Phone:218-778-6370
Mailing Address - Fax:
Practice Address - Street 1:12689 OLD HIGHWAY 169
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-8322
Practice Address - Country:US
Practice Address - Phone:218-778-6370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARY GARGANO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1006575-1-AFC310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility