Provider Demographics
NPI:1275577959
Name:JOURDAIN PERPICH EXTENDED CARE CENTER INC
Entity Type:Organization
Organization Name:JOURDAIN PERPICH EXTENDED CARE CENTER INC
Other - Org Name:JOURDAIN/PERPICH EXTENDED CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLAI
Authorized Official - Middle Name:KURTIS
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:218-679-3400
Mailing Address - Street 1:24856 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:RED LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56671-0399
Mailing Address - Country:US
Mailing Address - Phone:218-379-3400
Mailing Address - Fax:218-679-3434
Practice Address - Street 1:24856 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:RED LAKE
Practice Address - State:MN
Practice Address - Zip Code:56671-0399
Practice Address - Country:US
Practice Address - Phone:218-679-3400
Practice Address - Fax:218-679-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245535Medicare ID - Type Unspecified833840000