Provider Demographics
NPI:1104821891
Name:MADONNA TOWERS OF ROCHESTER, INC
Entity type:Organization
Organization Name:MADONNA TOWERS OF ROCHESTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERGIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-991-6519
Mailing Address - Street 1:4001 19TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-4505
Mailing Address - Country:US
Mailing Address - Phone:507-288-3911
Mailing Address - Fax:507-288-0393
Practice Address - Street 1:4001 19TH AVE NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-4505
Practice Address - Country:US
Practice Address - Phone:507-288-3911
Practice Address - Fax:507-288-0393
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEDICTINE HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-17
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328643314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN931216100Medicaid
MN24-5153AMedicare ID - Type Unspecified