Healthcare Provider Details

I. General information

NPI: 1316932254
Provider Name (Legal Business Name): BENEDICTINE CARE CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 PIONEER RD
RED WING MN
55066-3921
US

IV. Provider business mailing address

213 PIONEER RD
RED WING MN
55066-3921
US

V. Phone/Fax

Practice location:
  • Phone: 651-388-1234
  • Fax: 651-385-5444
Mailing address:
  • Phone: 651-388-1234
  • Fax: 651-385-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number326978
License Number StateMN

VIII. Authorized Official

Name: MR. MIKE SCHULTZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 651-388-1234