Provider Demographics
NPI:1285073783
Name:BROOKE MANOR INC
Entity type:Organization
Organization Name:BROOKE MANOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUOMINEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-590-7322
Mailing Address - Street 1:4660 AUNE RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MN
Mailing Address - Zip Code:55779-9682
Mailing Address - Country:US
Mailing Address - Phone:218-453-5262
Mailing Address - Fax:218-453-1023
Practice Address - Street 1:4878 HWY 31
Practice Address - Street 2:
Practice Address - City:BROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:55711
Practice Address - Country:US
Practice Address - Phone:218-453-5262
Practice Address - Fax:218-453-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN362531310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility