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NPI Code Detail

MEDICARE: SENIOR CARE WOODBURY, LLC

MEDICARE: SENIOR CARE WOODBURY, LLC
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 Facility332432MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18764WOOTHERMNBCBS
27122682OTHERMNMEDICA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4NH0133OTHERMNUCARE

General Provider Information

NPI Number : 1427183961
Entity Type Code : Organization
Provider Name (Legal Business Name) : SENIOR CARE WOODBURY, LLC
Provider Business Mailing Address
First Line : 7012 LAKE RD
Second Line :
City : SAINT PAUL
State : MN
Zip : 55125-2433
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7012 LAKE RD
Second Line :
City : SAINT PAUL
State : MN
Zip : 55125-2433
Country : US
Telephone Number : 651-735-6000
Fax Number :
Authorized Official
Title or Position : ACCOUNTANT
Name : NANCY SUE RICHTER
Credential :
Telephone Number : 612-431-7932
Provider Enumeration Date : 02/23/2007
Last Update Date : 09/02/2025

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Directions to “SENIOR CARE WOODBURY, LLC ” Practice Location

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