Healthcare Provider Details

I. General information

NPI: 1326757154
Provider Name (Legal Business Name): CENTRACARE HEALTH - BENSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 WISCONSIN AVE
BENSON MN
56215-1653
US

IV. Provider business mailing address

1406 6TH AVE N
SAINT CLOUD MN
56303-1900
US

V. Phone/Fax

Practice location:
  • Phone: 320-843-4232
  • Fax:
Mailing address:
  • Phone: 320-251-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BLAIR
Title or Position: CFO
Credential:
Phone: 320-255-5665