Provider Demographics
NPI:1124019690
Name:CATHOLIC ELDERCARE
Entity Type:Organization
Organization Name:CATHOLIC ELDERCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-379-1370
Mailing Address - Street 1:817 MAIN ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1931
Mailing Address - Country:US
Mailing Address - Phone:612-379-1370
Mailing Address - Fax:612-362-2414
Practice Address - Street 1:817 MAIN ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1931
Practice Address - Country:US
Practice Address - Phone:612-379-1370
Practice Address - Fax:612-362-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
MN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN375542800Medicaid
MN375542800Medicaid