Provider Demographics
NPI:1477573582
Name:GRACEVILLE HEALTH CENTER
Entity Type:Organization
Organization Name:GRACEVILLE HEALTH CENTER
Other - Org Name:GRACE VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BODENSTEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-435-7633
Mailing Address - Street 1:115 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56240-4847
Mailing Address - Country:US
Mailing Address - Phone:320-748-7223
Mailing Address - Fax:320-748-7225
Practice Address - Street 1:115 W 2ND ST
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:MN
Practice Address - Zip Code:56240-4847
Practice Address - Country:US
Practice Address - Phone:320-748-7223
Practice Address - Fax:320-748-7225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility