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NPI Code Detail

MEDICARE: PREMIER HEALTHCARE MANAGEMENT OF SANDSTONE, LLC

MEDICARE: PREMIER HEALTHCARE MANAGEMENT OF SANDSTONE, 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 Facility361354MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23B24EPIOTHERMNBCBS OF MINNESOTA
37114053OTHERMNMEDICA

General Provider Information

NPI Number : 1649273087
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER HEALTHCARE MANAGEMENT OF SANDSTONE, LLC
Provider Business Mailing Address
First Line : 109 COURT AVENUE SOUTH
Second Line :
City : SANDSTONE
State : MN
Zip : 55712
Country : US
Telephone Number : 320-245-3150
Fax Number : 320-245-3177
Provider Business Practice Location Address
First Line : 109 COURT AVE S
Second Line :
City : SANDSTONE
State : MN
Zip : 55072-5120
Country : US
Telephone Number : 320-245-3150
Fax Number : 302-245-3177
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. FRED STRUZYK
Credential :
Telephone Number : 320-764-1503
Provider Enumeration Date : 05/31/2005
Last Update Date : 10/13/2021

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