Healthcare Provider Details

I. General information

NPI: 1528026648
Provider Name (Legal Business Name): PAYNESVILLE AREA HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LUELLA ST
WATKINS MN
55389-1012
US

IV. Provider business mailing address

410 LUELLA ST
WATKINS MN
55389-1012
US

V. Phone/Fax

Practice location:
  • Phone: 320-764-2300
  • Fax: 320-764-2665
Mailing address:
  • Phone: 320-764-2300
  • Fax: 320-764-2665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number332123
License Number StateMN

VIII. Authorized Official

Name: BOBBE TEIGEN
Title or Position: CEO
Credential:
Phone: 320-243-3767