Provider Demographics
NPI:1689649790
Name:KNUTE NELSON
Entity Type:Organization
Organization Name:KNUTE NELSON
Other - Org Name:KNUTE NELSON CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUGISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-763-1164
Mailing Address - Street 1:420 12TH AVE E
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2612
Mailing Address - Country:US
Mailing Address - Phone:320-763-6653
Mailing Address - Fax:320-763-7548
Practice Address - Street 1:420 12TH AVE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2612
Practice Address - Country:US
Practice Address - Phone:320-763-6653
Practice Address - Fax:320-763-7548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0026257314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9701KNOtherBLUE CROSS BLUE SHIELD
MN178540100Medicaid
MN245435Medicare Oscar/Certification