Provider Demographics
NPI:1235482407
Name:VIDELL HEALTHCARE CAMDEN, L.L.C.
Entity Type:Organization
Organization Name:VIDELL HEALTHCARE CAMDEN, L.L.C.
Other - Org Name:CAMDEN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAFORTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-277-3197
Mailing Address - Street 1:512 49TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55430-3621
Mailing Address - Country:US
Mailing Address - Phone:612-287-3473
Mailing Address - Fax:
Practice Address - Street 1:512 49TH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55430-3621
Practice Address - Country:US
Practice Address - Phone:253-277-3197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIDELL HEALTHCARE, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-24
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245544Medicare Oscar/Certification