Healthcare Provider Details

I. General information

NPI: 1144699745
Provider Name (Legal Business Name): MINOT HEALTH AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAIN ST S
MINOT ND
58701-4499
US

IV. Provider business mailing address

5536 N KENT AVE
WHITEFISH BAY WI
53217-5155
US

V. Phone/Fax

Practice location:
  • Phone: 701-852-1255
  • Fax: 701-852-1134
Mailing address:
  • Phone: 636-698-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1041
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JEFFREY CHARLES HOEHN
Title or Position: MEMBER MANAGER
Credential:
Phone: 636-698-8600