Pine Ridge Residence INC

NPI #1811192271 in Bagley, Minnesota

Provider Information

NPI Number: 1811192271
Entity Type: Organization
Organization Name: Pine Ridge Residence INC
Primary Specialty: Intermediate Care Facility, Intellectual Disabilities
Enumeration Date: Jun 18, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 503 HALLAN AVE
City: Bagley
State: Minnesota
ZIP Code: 56621-0029
Phone: (218) 694-6716

Authorized Official

Name: MR. DONALD L BLOOFLAT
Title: ADMINISTRATOR
Phone: (218) 694-6716

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Intermediate Care Facility, Intellectual Disabilities	315P00000X	Primary

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