Provider Demographics
NPI:1144493669
Name:CARE-AGE COUNTRY HOME
Entity type:Organization
Organization Name:CARE-AGE COUNTRY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-732-3721
Mailing Address - Street 1:18846 EAGLE BEND RD
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-2073
Mailing Address - Country:US
Mailing Address - Phone:218-732-3721
Mailing Address - Fax:218-732-1208
Practice Address - Street 1:18846 EAGLE BEND RD
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-2073
Practice Address - Country:US
Practice Address - Phone:218-732-3721
Practice Address - Fax:218-732-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility