Provider Demographics
NPI:1013184647
Name:ST. OTTO'S CARE CENTER INC
Entity Type:Organization
Organization Name:ST. OTTO'S CARE CENTER INC
Other - Org Name:ST. OTTO'S CARE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-632-9281
Mailing Address - Street 1:920 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3540
Mailing Address - Country:US
Mailing Address - Phone:320-632-9281
Mailing Address - Fax:320-631-4106
Practice Address - Street 1:920 4TH ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3540
Practice Address - Country:US
Practice Address - Phone:320-632-9281
Practice Address - Fax:320-631-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNPENDING314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245257Medicare Oscar/Certification