MEDICARE: BENEDICTINE CARE CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	324150	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336135524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENEDICTINE CARE CENTERS

Provider Business Mailing Address
First Line	:	1101 BLACK OAK DR
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-8400
Country	:	US
Telephone Number	:	651-633-1686
Fax Number	:	651-633-5267

Provider Business Practice Location Address
First Line	:	1101 BLACK OAK DR
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-8400
Country	:	US
Telephone Number	:	651-633-1686
Fax Number	:	651-633-5267

Authorized Official
Title or Position	:	DIRECTOR, REIMBURSEMENT
Name	:	TRICIA L BERGIEN
Credential	:
Telephone Number	:	612-991-6519

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	03/11/2019

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