Healthcare Provider Details

I. General information

NPI: 1811997489
Provider Name (Legal Business Name): WARROAD CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 LAKE ST NW
WARROAD MN
56763-2026
US

IV. Provider business mailing address

1401 LAKE ST NW
WARROAD MN
56763-2026
US

V. Phone/Fax

Practice location:
  • Phone: 218-386-1235
  • Fax: 218-386-3548
Mailing address:
  • Phone: 218-386-1235
  • Fax: 218-386-3548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARK BERTILRUD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 218-386-1235