Healthcare Provider Details

I. General information

NPI: 1407852932
Provider Name (Legal Business Name): ST GERTRUDES HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 SARAZIN ST
SHAKOPEE MN
55379-9466
US

IV. Provider business mailing address

1850 SARAZIN ST
SHAKOPEE MN
55379-9466
US

V. Phone/Fax

Practice location:
  • Phone: 952-233-4400
  • Fax: 952-233-4476
Mailing address:
  • Phone: 952-233-4400
  • Fax: 952-233-4476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2867919
License Number StateMN

VIII. Authorized Official

Name: MS. MADDISEN BELPULSI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 952-233-4400