Healthcare Provider Details

I. General information

NPI: 1538169024
Provider Name (Legal Business Name): ANNANDALE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PARK ST E
ANNANDALE MN
55302-3060
US

IV. Provider business mailing address

500 PARK ST E
ANNANDALE MN
55302-3060
US

V. Phone/Fax

Practice location:
  • Phone: 320-274-3737
  • Fax: 320-274-3631
Mailing address:
  • Phone: 320-274-3737
  • Fax: 320-274-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number20856
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number00951
License Number StateMN

VIII. Authorized Official

Name: MR. JOHN A NELSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 320-274-3737