Healthcare Provider Details

I. General information

NPI: 1871610113
Provider Name (Legal Business Name): STEWARTVILLE NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 4TH ST NE
STEWARTVILLE MN
55976-1212
US

IV. Provider business mailing address

120 4TH ST NE
STEWARTVILLE MN
55976-1212
US

V. Phone/Fax

Practice location:
  • Phone: 507-533-4288
  • Fax: 507-533-1384
Mailing address:
  • Phone: 507-533-4288
  • Fax: 507-533-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number332716
License Number StateMN

VIII. Authorized Official

Name: MR. EUGENE GUSTASON
Title or Position: ADMINISTRATOR
Credential:
Phone: 507-533-4288