Provider Demographics
NPI:1336135524
Name:BENEDICTINE CARE CENTERS
Entity Type:Organization
Organization Name:BENEDICTINE CARE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERGIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-991-6519
Mailing Address - Street 1:1101 BLACK OAK DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-8400
Mailing Address - Country:US
Mailing Address - Phone:651-633-1686
Mailing Address - Fax:651-633-5267
Practice Address - Street 1:1101 BLACK OAK DR
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-8400
Practice Address - Country:US
Practice Address - Phone:651-633-1686
Practice Address - Fax:651-633-5267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN324150314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN810313500Medicaid
MN810313500Medicaid