Provider Demographics
NPI:1407852932
Name:ST GERTRUDES HEALTH CENTER
Entity Type:Organization
Organization Name:ST GERTRUDES HEALTH CENTER
Other - Org Name:ST GERTRUDES HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MADDISEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELPULSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-233-4400
Mailing Address - Street 1:1850 SARAZIN ST
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-9466
Mailing Address - Country:US
Mailing Address - Phone:952-233-4400
Mailing Address - Fax:952-233-4476
Practice Address - Street 1:1850 SARAZIN ST
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-9466
Practice Address - Country:US
Practice Address - Phone:952-233-4400
Practice Address - Fax:952-233-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2867919314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN440886100Medicaid