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General NPI Number Information
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NPI Number | 1215932728
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Entity Type | Organization
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Legal Business Name | VILLA ST. VINCENT
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 516 WALSH ST
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City | CROOKSTON
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State | MN
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Zip | 56716
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Country | US
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Telephone | 218-281-3424
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Fax | 218-281-4755
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Provider Business Mailing Address
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Address Line | 516 WALSH ST
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City | CROOKSTON
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State | MN
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Zip | 56716
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Country | US
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Telephone | 218-281-3424
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Fax | 218-281-4755
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | JUDY HULST
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Credential |
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Telephone | 218-281-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 352789
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 353890
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 328575
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 325662
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License Number State | MN
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