Healthcare Provider Details

I. General information

NPI: 1053393777
Provider Name (Legal Business Name): RED WING HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 WEST 4TH STREET
RED WING MN
55046
US

IV. Provider business mailing address

1412 WEST 4TH STREET
RED WING MN
55046
US

V. Phone/Fax

Practice location:
  • Phone: 651-388-2843
  • Fax: 651-388-9502
Mailing address:
  • Phone: 651-388-2843
  • Fax: 651-388-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number329002
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number349026
License Number StateMN

VIII. Authorized Official

Name: MR. PAUL J. CONTRIS
Title or Position: PRESIDENT
Credential:
Phone: 480-730-1573