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General NPI Number Information
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NPI Number | 1528384310
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Entity Type | Organization
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Legal Business Name | AUGUSTANA MERCY CARE CENTER LLC
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Dates
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Enumeration Date | 04/19/2010
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 710 S KENWOOD AVE
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City | MOOSE LAKE
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State | MN
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Zip | 55767-9405
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Country | US
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Telephone | 218-485-4481
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Fax |
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Provider Business Mailing Address
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Address Line | 710 S KENWOOD AVE
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City | MOOSE LAKE
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State | MN
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Zip | 55767-9405
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Country | US
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Telephone | 218-485-4481
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE VP OF REVENUE CYCLE MGMT
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Name | SEELOCHANI STADTHERR
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Credential |
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Telephone | 952-855-5041
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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 | 349655
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License Number State | MN
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