MEDICARE: BENEDICT COURT

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
1	310400000X	Assisted Living Facility	344720	MN

General Provider Information

NPI Number	:	1831417559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENEDICT COURT

Provider Business Mailing Address
First Line	:	1980 15TH AVE SE
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56304-2380
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1980 15TH AVE SE
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56304-2380
Country	:	US
Telephone Number	:	320-252-0010
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LINDA DOERR
Credential	:
Telephone Number	:	320-252-0010

Provider Enumeration Date	:	05/05/2010
Last Update Date	:	05/05/2010

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Directions to “BENEDICT COURT ” Practice Location

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