Provider Demographics
NPI:1336359900
Name:PRESBYTERIAN FAMILY FOUNDATION
Entity type:Organization
Organization Name:PRESBYTERIAN FAMILY FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-235-5897
Mailing Address - Street 1:901 HIGHWAY 71 NE
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-2654
Mailing Address - Country:US
Mailing Address - Phone:320-235-5897
Mailing Address - Fax:
Practice Address - Street 1:110 5TH ST N
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:MN
Practice Address - Zip Code:56209
Practice Address - Country:US
Practice Address - Phone:320-974-8070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN416043600Medicaid