Provider Demographics
NPI:1831495514
Name:BENEDICTINE LIVING COMMUNITY OF NEW LONDON
Entity Type:Organization
Organization Name:BENEDICTINE LIVING COMMUNITY OF NEW LONDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-354-2231
Mailing Address - Street 1:100 GLENOAKS DR
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:MN
Mailing Address - Zip Code:56273-9580
Mailing Address - Country:US
Mailing Address - Phone:320-354-2231
Mailing Address - Fax:320-354-2060
Practice Address - Street 1:100 GLENOAKS DR
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:MN
Practice Address - Zip Code:56273-9580
Practice Address - Country:US
Practice Address - Phone:320-354-2231
Practice Address - Fax:320-354-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
245360Medicare Oscar/Certification