Provider Demographics
NPI:1932203320
Name:CITY OF CLARA CITY
Entity type:Organization
Organization Name:CITY OF CLARA CITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:N
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-847-7216
Mailing Address - Street 1:1012 DIVISION ST N
Mailing Address - Street 2:
Mailing Address - City:CLARA CITY
Mailing Address - State:MN
Mailing Address - Zip Code:56222-1141
Mailing Address - Country:US
Mailing Address - Phone:320-847-7216
Mailing Address - Fax:320-847-3553
Practice Address - Street 1:1012 DIVISION STREET NORTH
Practice Address - Street 2:
Practice Address - City:CLARA CITY
Practice Address - State:MN
Practice Address - Zip Code:56222-0797
Practice Address - Country:US
Practice Address - Phone:320-847-2221
Practice Address - Fax:320-847-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN335473314000000X
MN352428314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNH0229OtherUCARE PROVIDER NUMBER
MN454040900Medicaid
MN0B50CLOtherBCBS PROVIDER NUMBER
MNNH0229OtherUCARE PROVIDER NUMBER
MN454040900Medicaid