Provider Demographics
NPI:1770524555
Name:SANFORD HEALTH NETWORK
Entity type:Organization
Organization Name:SANFORD HEALTH NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FUNK
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:507-483-2668
Mailing Address - Street 1:603 LOUISIANA AVENUE
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MN
Mailing Address - Zip Code:56110
Mailing Address - Country:US
Mailing Address - Phone:507-483-2668
Mailing Address - Fax:507-483-2610
Practice Address - Street 1:603 LOUISIANA AVENUE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MN
Practice Address - Zip Code:56110
Practice Address - Country:US
Practice Address - Phone:507-483-2668
Practice Address - Fax:507-483-2610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330433314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN662727700Medicaid
MN662727700Medicaid