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NPI Code Detail

MEDICARE: VIDELL HEALTHCARE CAMDEN, L.L.C.

MEDICARE: VIDELL HEALTHCARE CAMDEN, L.L.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1235482407
Entity Type Code : Organization
Provider Name (Legal Business Name) : VIDELL HEALTHCARE CAMDEN, L.L.C.
Provider Business Mailing Address
First Line : 512 49TH AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55430-3621
Country : US
Telephone Number : 612-287-3473
Fax Number :
Provider Business Practice Location Address
First Line : 512 49TH AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55430-3621
Country : US
Telephone Number : 253-277-3197
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : STEPHEN J. LAFORTE
Credential :
Telephone Number : 253-277-3197
Provider Enumeration Date : 10/24/2012
Last Update Date : 04/19/2013

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