Healthcare Provider Details

I. General information

NPI: 1346238094
Provider Name (Legal Business Name): PARK VIEW CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 07/31/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PARK LN
BUFFALO MN
55313-1336
US

IV. Provider business mailing address

200 PARK LN
BUFFALO MN
55313-1336
US

V. Phone/Fax

Practice location:
  • Phone: 763-682-1131
  • Fax: 763-684-1044
Mailing address:
  • Phone: 763-682-1131
  • Fax: 763-684-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number328223
License Number StateMN

VIII. Authorized Official

Name: SEELOCHANI STADTHERR
Title or Position: SENIOR DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 952-855-5041