Provider Demographics
NPI:1194849588
Name:ERICKSON COMPANIES, INC.
Entity Type:Organization
Organization Name:ERICKSON COMPANIES, INC.
Other - Org Name:MINNEOTA MANOR HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-872-5300
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:MINNEOTA
Mailing Address - State:MN
Mailing Address - Zip Code:56264-0117
Mailing Address - Country:US
Mailing Address - Phone:507-872-5300
Mailing Address - Fax:507-872-5359
Practice Address - Street 1:700 NORTH MONROE STREET
Practice Address - Street 2:
Practice Address - City:MINNEOTA
Practice Address - State:MN
Practice Address - Zip Code:56264
Practice Address - Country:US
Practice Address - Phone:507-872-5300
Practice Address - Fax:507-872-5359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN337862314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245496Medicare Oscar/Certification