Provider Demographics
NPI:1316932254
Name:BENEDICTINE CARE CENTERS
Entity type:Organization
Organization Name:BENEDICTINE CARE CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-388-1234
Mailing Address - Street 1:213 PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-3921
Mailing Address - Country:US
Mailing Address - Phone:651-388-1234
Mailing Address - Fax:651-385-5444
Practice Address - Street 1:213 PIONEER RD
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-3921
Practice Address - Country:US
Practice Address - Phone:651-388-1234
Practice Address - Fax:651-385-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN326978314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNH0459OtherUCARE PROVIDER #
MN178977500Medicaid
MN9691HAOtherBLUE CROSS PROVIDER #
MN178977500Medicaid