Healthcare Provider Details

I. General information

NPI: 1710972112
Provider Name (Legal Business Name): CENTRAL HEALTH CARE OF LE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N CORDOVA AVE
LE CENTER MN
56057-1704
US

IV. Provider business mailing address

444 N CORDOVA AVE
LE CENTER MN
56057-1704
US

V. Phone/Fax

Practice location:
  • Phone: 507-357-2275
  • Fax: 507-357-4346
Mailing address:
  • Phone: 507-357-2275
  • Fax: 507-357-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number328184
License Number StateMN

VIII. Authorized Official

Name: SETH PROBST
Title or Position: OWNER
Credential:
Phone: 507-357-2275