Healthcare Provider Details

I. General information

NPI: 1528384310
Provider Name (Legal Business Name): AUGUSTANA MERCY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S KENWOOD AVE
MOOSE LAKE MN
55767-9405
US

IV. Provider business mailing address

710 S KENWOOD AVE
MOOSE LAKE MN
55767-9405
US

V. Phone/Fax

Practice location:
  • Phone: 218-485-4481
  • Fax:
Mailing address:
  • Phone: 218-485-4481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number349655
License Number StateMN

VIII. Authorized Official

Name: SEELOCHANI STADTHERR
Title or Position: ASSOCIATE VP OF REVENUE CYCLE MGMT
Credential:
Phone: 952-855-5041