Provider Demographics
NPI:1093775991
Name:BENEDICTINE CARE CENTERS
Entity Type:Organization
Organization Name:BENEDICTINE CARE CENTERS
Other - Org Name:ST. ELIGIUS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:IKOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-628-9113
Mailing Address - Street 1:7700 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2154
Mailing Address - Country:US
Mailing Address - Phone:218-628-9113
Mailing Address - Fax:218-628-0395
Practice Address - Street 1:7700 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2154
Practice Address - Country:US
Practice Address - Phone:218-628-9113
Practice Address - Fax:218-628-0395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEDICTNE HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-24
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330883314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN940220900Medicaid
MN9733LAOtherBCBS
FMNH0189OtherUCARE
MN140015OtherFIRST PLAN
MN7111801OtherMEDICA
MN940220900Medicaid
MN940220900Medicaid
MN7111801OtherMEDICA