Provider Demographics
NPI:1578788170
Name:SACRED HEART CARE CENTER INC
Entity Type:Organization
Organization Name:SACRED HEART CARE CENTER INC
Other - Org Name:SACRED HEART HOSPICE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MATHEWS
Authorized Official - Last Name:HALVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:507-433-1808
Mailing Address - Street 1:1200 12TH ST SW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-2619
Mailing Address - Country:US
Mailing Address - Phone:507-433-1808
Mailing Address - Fax:507-433-8012
Practice Address - Street 1:1200 12TH ST SW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-2619
Practice Address - Country:US
Practice Address - Phone:507-433-1808
Practice Address - Fax:507-433-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN333789314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN935742400Medicaid
MN935742400Medicaid