Provider Demographics
NPI:1922388438
Name:BARROSS MANOR, LLC
Entity Type:Organization
Organization Name:BARROSS MANOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROPRIETOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CORTNEY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BUCHHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:218-834-6174
Mailing Address - Street 1:414 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-1614
Mailing Address - Country:US
Mailing Address - Phone:218-310-2562
Mailing Address - Fax:
Practice Address - Street 1:414 1ST AVE
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1614
Practice Address - Country:US
Practice Address - Phone:218-310-2562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN353079310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility