Provider Demographics
NPI:1043442221
Name:ADRIAN CARE CENTER, INC.
Entity Type:Organization
Organization Name:ADRIAN CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-360-5595
Mailing Address - Street 1:603 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MN
Mailing Address - Zip Code:56110-1051
Mailing Address - Country:US
Mailing Address - Phone:507-827-5800
Mailing Address - Fax:507-827-5801
Practice Address - Street 1:603 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MN
Practice Address - Zip Code:56110-1051
Practice Address - Country:US
Practice Address - Phone:507-827-5800
Practice Address - Fax:507-827-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN292923000Medicaid