Provider Demographics
NPI:1528336005
Name:PARK GARDENS OF FERGUS FALLS, LLC
Entity type:Organization
Organization Name:PARK GARDENS OF FERGUS FALLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-888-2923
Mailing Address - Street 1:215 SKOGMO BLVD
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1289
Mailing Address - Country:US
Mailing Address - Phone:952-888-2923
Mailing Address - Fax:952-345-4465
Practice Address - Street 1:215 SKOGMO BLVD
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1289
Practice Address - Country:US
Practice Address - Phone:952-888-2923
Practice Address - Fax:952-345-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility