Healthcare Provider Details

I. General information

NPI: 1730256207
Provider Name (Legal Business Name): WELCOV HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 S HIGHWAY 169
GRAND RAPIDS MN
55744-9552
US

IV. Provider business mailing address

2801 S HIGHWAY 169
GRAND RAPIDS MN
55744-9552
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-3431
  • Fax: 218-327-3217
Mailing address:
  • Phone: 218-326-3431
  • Fax: 218-327-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number331604
License Number StateMN

VIII. Authorized Official

Name: CHRISTINE DOLS
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 952-873-7934