Provider Demographics
NPI:1801847702
Name:PREMIER HEALTHCARE MANAGEMENT OF LONG PRAIRIE LLC
Entity Type:Organization
Organization Name:PREMIER HEALTHCARE MANAGEMENT OF LONG PRAIRIE LLC
Other - Org Name:LONG PRAIRIE HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:STRUZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-764-1503
Mailing Address - Street 1:20 9TH ST SE
Mailing Address - Street 2:
Mailing Address - City:LONG PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56347-1404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:320-764-2300
Practice Address - Street 1:20 SE NINTH STREET
Practice Address - Street 2:CENTRA CARE HEALTH SYSTEM- LONG PRAIRE
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347-1404
Practice Address - Country:US
Practice Address - Phone:320-732-2141
Practice Address - Fax:320-732-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331051314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN278525100Medicaid
MN278525100Medicaid