Provider Demographics
NPI:1679568505
Name:BENEDICTINE CARE CENTERS
Entity Type:Organization
Organization Name:BENEDICTINE CARE CENTERS
Other - Org Name:ST. ISIDORE HEALTH CENTER OF GREENWOOD PRAIRIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-534-3191
Mailing Address - Street 1:800 2ND AVENUE NW
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55964-1097
Mailing Address - Country:US
Mailing Address - Phone:507-534-3191
Mailing Address - Fax:507-534-2778
Practice Address - Street 1:800 2ND AVENUE NW
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:MN
Practice Address - Zip Code:55964-1097
Practice Address - Country:US
Practice Address - Phone:507-534-3191
Practice Address - Fax:507-534-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328483314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN100182500Medicaid
MN100182500Medicaid