Provider Demographics
NPI:1528026648
Name:PAYNESVILLE AREA HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PAYNESVILLE AREA HOSPITAL DISTRICT
Other - Org Name:HILLTOP CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOBBE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-243-3767
Mailing Address - Street 1:410 LUELLA ST
Mailing Address - Street 2:
Mailing Address - City:WATKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55389-1012
Mailing Address - Country:US
Mailing Address - Phone:320-764-2300
Mailing Address - Fax:320-764-2665
Practice Address - Street 1:410 LUELLA ST
Practice Address - Street 2:
Practice Address - City:WATKINS
Practice Address - State:MN
Practice Address - Zip Code:55389-1012
Practice Address - Country:US
Practice Address - Phone:320-764-2300
Practice Address - Fax:320-764-2665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN332123314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
3G60PAOtherBCBS
03072202704OtherPRIMEWEST
MN138450300Medicaid
MN138450300Medicaid