Provider Demographics
NPI:1699008805
Name:SHARON SHOFNER ADULT FOSTER CARE
Entity Type:Organization
Organization Name:SHARON SHOFNER ADULT FOSTER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:CHLORINCE
Authorized Official - Last Name:SHOFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-453-1083
Mailing Address - Street 1:8783 2ND ST SOUTH
Mailing Address - Street 2:
Mailing Address - City:BROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:55711
Mailing Address - Country:US
Mailing Address - Phone:218-453-1083
Mailing Address - Fax:
Practice Address - Street 1:8783 2ND ST SOUTH
Practice Address - Street 2:
Practice Address - City:BROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:55711
Practice Address - Country:US
Practice Address - Phone:218-453-1083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN201343-3-AFC320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities