Healthcare Provider Details

I. General information

NPI: 1801847702
Provider Name (Legal Business Name): PREMIER HEALTHCARE MANAGEMENT OF LONG PRAIRIE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SE NINTH STREET CENTRA CARE HEALTH SYSTEM- LONG PRAIRE
LONG PRAIRIE MN
56347-1404
US

IV. Provider business mailing address

20 9TH ST SE
LONG PRAIRIE MN
56347-1404
US

V. Phone/Fax

Practice location:
  • Phone: 320-732-2141
  • Fax: 320-732-3802
Mailing address:
  • Phone:
  • Fax: 320-764-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number331051
License Number StateMN

VIII. Authorized Official

Name: FRED STRUZYK
Title or Position: SEC/TREASURER
Credential:
Phone: 320-764-1503