MEDICARE: PREMIER HEALTHCARE MANAGEMENT OF LONG PRAIRIE

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1932837580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HEALTHCARE MANAGEMENT OF LONG PRAIRIE

Provider Business Mailing Address
First Line	:	410 LUELLA ST
Second Line	:
City	:	WATKINS
State	:	MN
Zip	:	55389-1012
Country	:	US
Telephone Number	:	320-764-1503
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 CENTRACARE DR
Second Line	:
City	:	LONG PRAIRIE
State	:	MN
Zip	:	56347-2102
Country	:	US
Telephone Number	:	320-764-1503
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FRED STRUZYK
Credential	:
Telephone Number	:	320-249-7364

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	05/01/2023

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