Provider Demographics
NPI:1447677380
Name:CHRISTY LYNN MARK
Entity type:Organization
Organization Name:CHRISTY LYNN MARK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-998-4787
Mailing Address - Street 1:1324 HARMONY PL
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1533
Mailing Address - Country:US
Mailing Address - Phone:218-998-4787
Mailing Address - Fax:218-736-4250
Practice Address - Street 1:1324 HARMONY PL
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1533
Practice Address - Country:US
Practice Address - Phone:218-998-4787
Practice Address - Fax:218-736-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1073471-2-AFC311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA439420000OtherPROVIDER #
MN1073471-2-AFCOtherLICENCE #