Healthcare Provider Details

I. General information

NPI: 1801996129
Provider Name (Legal Business Name): PARKVIEW CARE CENTER - ALBERT LEA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 10TH ST SE
WELLS MN
56097-1814
US

IV. Provider business mailing address

55 10TH ST SE
WELLS MN
56097-1814
US

V. Phone/Fax

Practice location:
  • Phone: 507-553-3115
  • Fax:
Mailing address:
  • Phone: 507-553-3115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number329923
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number329923
License Number StateMN

VIII. Authorized Official

Name: MR. STEPHEN WALDHOFF
Title or Position: CAO
Credential:
Phone: 507-373-2384