Provider Demographics
NPI:1609198720
Name:CITY OF ADRIAN
Entity Type:Organization
Organization Name:CITY OF ADRIAN
Other - Org Name:ADRIAN COUNTRY LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MULDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-483-2580
Mailing Address - Street 1:603 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MN
Mailing Address - Zip Code:56110-1051
Mailing Address - Country:US
Mailing Address - Phone:507-483-2580
Mailing Address - Fax:507-483-2610
Practice Address - Street 1:603 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MN
Practice Address - Zip Code:56110-1051
Practice Address - Country:US
Practice Address - Phone:507-483-2580
Practice Address - Fax:507-483-2610
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF ADRIAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-16
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN346779314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility