Provider Demographics
NPI:1033995808
Name:MINNEWASKA COMMUNITY HOMECARE LLC
Entity Type:Organization
Organization Name:MINNEWASKA COMMUNITY HOMECARE LLC
Other - Org Name:MINNEWASKA COMMUNITY HOMECARE LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EHRENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-239-7156
Mailing Address - Street 1:303 7TH ST S
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MN
Mailing Address - Zip Code:56296-1740
Mailing Address - Country:US
Mailing Address - Phone:320-563-8124
Mailing Address - Fax:
Practice Address - Street 1:303 7TH ST S
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MN
Practice Address - Zip Code:56296-1740
Practice Address - Country:US
Practice Address - Phone:320-563-8124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINNEWASKA LUTHERAN HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-06
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility