Healthcare Provider Details

I. General information

NPI: 1831495514
Provider Name (Legal Business Name): BENEDICTINE LIVING COMMUNITY OF NEW LONDON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GLENOAKS DR
NEW LONDON MN
56273-9580
US

IV. Provider business mailing address

100 GLENOAKS DR
NEW LONDON MN
56273-9580
US

V. Phone/Fax

Practice location:
  • Phone: 320-354-2231
  • Fax: 320-354-2060
Mailing address:
  • Phone: 320-354-2231
  • Fax: 320-354-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES LAINE
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 320-354-2231