Provider Demographics
NPI:1295836237
Name:ELDERCARE OF BEMIDJI, INC
Entity Type:Organization
Organization Name:ELDERCARE OF BEMIDJI, INC
Other - Org Name:HAVENWOOD CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CASPERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-766-1154
Mailing Address - Street 1:1633 DELTON AVE NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2537
Mailing Address - Country:US
Mailing Address - Phone:218-444-1745
Mailing Address - Fax:218-444-1744
Practice Address - Street 1:1633 DELTON AVE NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-2537
Practice Address - Country:US
Practice Address - Phone:218-444-1745
Practice Address - Fax:218-444-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN333677314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN255822000Medicaid