Provider Demographics
NPI:1558359273
Name:AMERICAN BAPTIST HOMES OF THE MIDWEST
Entity Type:Organization
Organization Name:AMERICAN BAPTIST HOMES OF THE MIDWEST
Other - Org Name:THORNECREST RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RESIDENT RECEIVABLES
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-551-2110
Mailing Address - Street 1:1201 GARFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-3637
Mailing Address - Country:US
Mailing Address - Phone:507-373-2311
Mailing Address - Fax:507-377-1216
Practice Address - Street 1:1201 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-3637
Practice Address - Country:US
Practice Address - Phone:507-373-2311
Practice Address - Fax:507-377-1216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN144343700Medicaid