Provider Demographics
NPI:1467456822
Name:AICOTA HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:AICOTA HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:B
Authorized Official - Last Name:MATALAMAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-927-2164
Mailing Address - Street 1:850 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-1140
Mailing Address - Country:US
Mailing Address - Phone:218-927-2164
Mailing Address - Fax:218-927-6436
Practice Address - Street 1:850 2ND ST NW
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-1140
Practice Address - Country:US
Practice Address - Phone:218-927-2164
Practice Address - Fax:218-927-6436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN325756314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN908540800Medicaid
MN908540800Medicaid