Healthcare Provider Details

I. General information

NPI: 1639472426
Provider Name (Legal Business Name): WILLMAR CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUSSELL ST NW
WILLMAR MN
56201-2583
US

IV. Provider business mailing address

500 RUSSELL ST NW
WILLMAR MN
56201-2583
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-3181
  • Fax:
Mailing address:
  • Phone: 320-235-3181
  • Fax: 320-235-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GARETT ROBERTSON
Title or Position: CEO
Credential:
Phone: 801-296-5105