Provider Demographics
NPI:1790230936
Name:HOSPITALITY HOUSE OF DAYTON LAKE
Entity Type:Organization
Organization Name:HOSPITALITY HOUSE OF DAYTON LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:218-205-0426
Mailing Address - Street 1:19758 DAYTON HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-7621
Mailing Address - Country:US
Mailing Address - Phone:218-739-1046
Mailing Address - Fax:218-737-0028
Practice Address - Street 1:19758 DAYTON HOLLOW LN
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-7621
Practice Address - Country:US
Practice Address - Phone:218-739-1046
Practice Address - Fax:218-737-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNAPPLIED311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home