Provider Demographics
NPI:1578557484
Name:AH GWAH CHING CENTER
Entity Type:Organization
Organization Name:AH GWAH CHING CENTER
Other - Org Name:STATE OF MINNESOTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SITE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-547-8303
Mailing Address - Street 1:7232 AH GWAH CHING RD NW
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MN
Mailing Address - Zip Code:56484-3001
Mailing Address - Country:US
Mailing Address - Phone:218-547-8300
Mailing Address - Fax:218-547-8450
Practice Address - Street 1:7232 AH GWAH CHING RD NW
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MN
Practice Address - Zip Code:56484-3001
Practice Address - Country:US
Practice Address - Phone:218-547-8300
Practice Address - Fax:218-547-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
328637314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN328637OtherSTATE LICENSE NO.