Provider Demographics
NPI:1689783987
Name:COUNTY OF DODGE
Entity Type:Organization
Organization Name:COUNTY OF DODGE
Other - Org Name:FAIRVIEW CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING HOME ADMINIS
Authorized Official - Phone:507-635-6401
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:702 - 10TH AVENUE N.W.
Mailing Address - City:DODGE CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55927-0010
Mailing Address - Country:US
Mailing Address - Phone:507-374-2578
Mailing Address - Fax:507-374-2907
Practice Address - Street 1:702 10TH AVE NW
Practice Address - Street 2:
Practice Address - City:DODGE CENTER
Practice Address - State:MN
Practice Address - Zip Code:55927-9172
Practice Address - Country:US
Practice Address - Phone:507-374-2578
Practice Address - Fax:507-374-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331818314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN13420100Medicaid
MNNH0452OtherSOUTH COUNTRY HEALTH ALLI
MN134240100Medicaid
9658FAOtherBLUE CROSS BLUE SHIELD
MN13420100Medicaid