Provider Demographics
NPI:1992890008
Name:TUFF VILLAGE
Entity type:Organization
Organization Name:TUFF VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOUSING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENGEVELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-962-3500
Mailing Address - Street 1:301 CO RD 6
Mailing Address - Street 2:
Mailing Address - City:HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:56138-1017
Mailing Address - Country:US
Mailing Address - Phone:507-962-3500
Mailing Address - Fax:507-962-3590
Practice Address - Street 1:301 CO RD 6
Practice Address - Street 2:
Practice Address - City:HILLS
Practice Address - State:MN
Practice Address - Zip Code:56138-1017
Practice Address - Country:US
Practice Address - Phone:507-962-3500
Practice Address - Fax:507-962-3590
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUFF MEMORIAL HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN759418600310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN759418600Medicaid