Provider Demographics
NPI:1790785194
Name:TUFF MEMORIAL HOME
Entity Type:Organization
Organization Name:TUFF MEMORIAL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DAHLQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-962-3275
Mailing Address - Street 1:505 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:56138-1017
Mailing Address - Country:US
Mailing Address - Phone:507-962-3275
Mailing Address - Fax:507-962-3277
Practice Address - Street 1:505 E 4TH ST
Practice Address - Street 2:
Practice Address - City:HILLS
Practice Address - State:MN
Practice Address - Zip Code:56138-1017
Practice Address - Country:US
Practice Address - Phone:507-962-3275
Practice Address - Fax:507-962-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328220313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9504TUOtherBLUE CROSS/BLUE SHIELD #
MN245548Medicare ID - Type UnspecifiedMEDICARE NUMBER