Healthcare Provider Details

I. General information

NPI: 1932203320
Provider Name (Legal Business Name): CITY OF CLARA CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 DIVISION STREET NORTH
CLARA CITY MN
56222-0797
US

IV. Provider business mailing address

1012 DIVISION ST N
CLARA CITY MN
56222-1141
US

V. Phone/Fax

Practice location:
  • Phone: 320-847-2221
  • Fax: 320-847-3553
Mailing address:
  • Phone: 320-847-7216
  • Fax: 320-847-3553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number335473
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number352428
License Number StateMN

VIII. Authorized Official

Name: MATTHEW N BLUM
Title or Position: ADMINISTRATOR
Credential:
Phone: 320-847-7216