MEDICARE: CITY OF CLARA CITY

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	314000000X	Skilled Nursing Facility	335473	MN
2	314000000X	Skilled Nursing Facility	352428	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NH0229	OTHER	MN	UCARE PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0B50CL	OTHER	MN	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1932203320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF CLARA CITY

Provider Business Mailing Address
First Line	:	1012 DIVISION ST N
Second Line	:
City	:	CLARA CITY
State	:	MN
Zip	:	56222-1141
Country	:	US
Telephone Number	:	320-847-7216
Fax Number	:	320-847-3553

Provider Business Practice Location Address
First Line	:	1012 DIVISION STREET NORTH
Second Line	:
City	:	CLARA CITY
State	:	MN
Zip	:	56222-0797
Country	:	US
Telephone Number	:	320-847-2221
Fax Number	:	320-847-3553

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MATTHEW N BLUM
Credential	:
Telephone Number	:	320-847-7216

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	09/19/2024

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Directions to “CITY OF CLARA CITY ” Practice Location

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