Provider Demographics
NPI:1952551293
Name:OUR HOUSE OF MURRAY COUNTY
Entity type:Organization
Organization Name:OUR HOUSE OF MURRAY COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NONA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAGNUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-836-8114
Mailing Address - Street 1:36 PARK DR
Mailing Address - Street 2:PO BOX 86
Mailing Address - City:SLAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:56172-1050
Mailing Address - Country:US
Mailing Address - Phone:507-836-8114
Mailing Address - Fax:507-836-6462
Practice Address - Street 1:36 PARK DR
Practice Address - Street 2:
Practice Address - City:SLAYTON
Practice Address - State:MN
Practice Address - Zip Code:56172-1050
Practice Address - Country:US
Practice Address - Phone:507-836-8114
Practice Address - Fax:507-836-6462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPICE OF MURRAY COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN337555251G00000X
MN219229-4-AFC253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN240897000Medicaid