Provider Demographics
NPI:1578875621
Name:BENEDICTINE LIVING COMMUNITY OWATONNA
Entity Type:Organization
Organization Name:BENEDICTINE LIVING COMMUNITY OWATONNA
Other - Org Name:KODA LIVING COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-444-4200
Mailing Address - Street 1:2255 30TH ST NW
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-5704
Mailing Address - Country:US
Mailing Address - Phone:507-444-4206
Mailing Address - Fax:507-446-4944
Practice Address - Street 1:2255 30TH ST NW
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5704
Practice Address - Country:US
Practice Address - Phone:507-444-4200
Practice Address - Fax:507-446-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1578875621OtherNPI
245426Medicare Oscar/Certification