Provider Demographics
NPI:1679783997
Name:LRHC LONG TERM CARE FACILITIES, INC.
Entity Type:Organization
Organization Name:LRHC LONG TERM CARE FACILITIES, INC.
Other - Org Name:MILL STREET RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SIEMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-736-8590
Mailing Address - Street 1:802 S MILL ST
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2750
Mailing Address - Country:US
Mailing Address - Phone:218-739-2900
Mailing Address - Fax:218-739-2192
Practice Address - Street 1:802 S MILL ST
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2750
Practice Address - Country:US
Practice Address - Phone:218-739-2900
Practice Address - Fax:218-739-2192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN335628310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN825640300Medicaid