Provider Demographics
NPI:1427145762
Name:ELDERCARE OF BEMIDJI, INC
Entity type:Organization
Organization Name:ELDERCARE OF BEMIDJI, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CASPERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-766-1154
Mailing Address - Street 1:1711 DELTON AVE NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2536
Mailing Address - Country:US
Mailing Address - Phone:218-444-3047
Mailing Address - Fax:218-444-9060
Practice Address - Street 1:1711 DELTON AVE NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-2536
Practice Address - Country:US
Practice Address - Phone:218-444-3047
Practice Address - Fax:218-444-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN333136310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA459824500Medicaid