Provider Demographics
NPI:1821092875
Name:BENEDICTINE LIVING COMMUNITY OF ST. PETER
Entity Type:Organization
Organization Name:BENEDICTINE LIVING COMMUNITY OF ST. PETER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:NELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-934-8273
Mailing Address - Street 1:627 PARK ROW
Mailing Address - Street 2:
Mailing Address - City:ST PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-1336
Mailing Address - Country:US
Mailing Address - Phone:507-934-2203
Mailing Address - Fax:507-931-7333
Practice Address - Street 1:627 PARK ROW
Practice Address - Street 2:
Practice Address - City:ST PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-1336
Practice Address - Country:US
Practice Address - Phone:507-934-2203
Practice Address - Fax:507-931-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327205314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN849623400Medicaid
MN849623400Medicaid