Healthcare Provider Details

I. General information

NPI: 1891876181
Provider Name (Legal Business Name): TWEETEN LUTHERAN HEALTHCARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 5TH AVE SE
SPRING GROVE MN
55974-1318
US

IV. Provider business mailing address

125 5TH AVE SE
SPRING GROVE MN
55974-1318
US

V. Phone/Fax

Practice location:
  • Phone: 507-498-3211
  • Fax: 507-498-3228
Mailing address:
  • Phone: 507-498-3211
  • Fax: 507-498-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number332995
License Number StateMN

VIII. Authorized Official

Name: TIM SAMUELSON
Title or Position: CEO
Credential:
Phone: 507-498-3211