Provider Demographics
NPI:1316931645
Name:CHOSEN VALLEY CARE CENTER, INC
Entity type:Organization
Organization Name:CHOSEN VALLEY CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HAAKENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-867-4220
Mailing Address - Street 1:1102 LIBERTY ST SE
Mailing Address - Street 2:
Mailing Address - City:CHATFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55923-1448
Mailing Address - Country:US
Mailing Address - Phone:507-867-4220
Mailing Address - Fax:507-867-0080
Practice Address - Street 1:1102 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:CHATFIELD
Practice Address - State:MN
Practice Address - Zip Code:55923-1448
Practice Address - Country:US
Practice Address - Phone:507-867-4220
Practice Address - Fax:507-867-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN329921314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNH 0250OtherUCARE PROVIDER #
MN9752CHOtherBCBS INS PROVIDER #
MNNH 0250OtherUCARE PROVIDER #