Provider Demographics
NPI:1932181765
Name:AFTENRO SOCIETY HOME FOR THE AGED
Entity Type:Organization
Organization Name:AFTENRO SOCIETY HOME FOR THE AGED
Other - Org Name:AFTENRO HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-728-6600
Mailing Address - Street 1:510 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4902
Mailing Address - Country:US
Mailing Address - Phone:218-728-6600
Mailing Address - Fax:218-728-5452
Practice Address - Street 1:510 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4902
Practice Address - Country:US
Practice Address - Phone:218-728-6600
Practice Address - Fax:218-728-5452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327386313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN140027OtherFIRST PLAN OF MINNESOTA
MNNH0477OtherU-CARE OF MINNESOTA
MN71-80491OtherMEDICA