Henry Hagen Residence
Intermediate Care Facility, Intellectual Disabilities in Hastings, MN. Organization (NPI-2).
NPI number1194901751
StatusActive
Last updated in NPPESJan 14, 2008
Details
- NPI
- 1194901751
- Entity type
- Organization (NPI-2)
- Legal business name
- Henry Hagen Residence
- Organization subpart
- No
- Enumeration date
- Jan 14, 2008
- Last updated
- Jan 14, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 315P00000X | Intermediate Care Facility, Intellectual Disabilities | 01091 | MN | Yes |
Practice location
19845 Lillehei AveHastings, MN 55033-9354
Phone 651-437-9363 · Fax 651-437-9363
Mailing address
19845 Lillehei AveHastings, MN 55033-9354
Phone 651-437-9363 · Fax 651-437-9363
Authorized official
Roger David Reynolds
Owner
6516038881
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