Provider Demographics
NPI:1891755849
Name:BENEDICTINE HEALTH CENTER
Entity Type:Organization
Organization Name:BENEDICTINE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMAINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-723-6430
Mailing Address - Street 1:935 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4951
Mailing Address - Country:US
Mailing Address - Phone:218-723-6408
Mailing Address - Fax:218-723-6449
Practice Address - Street 1:935 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4951
Practice Address - Country:US
Practice Address - Phone:218-723-6408
Practice Address - Fax:218-723-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
MN329925314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN819240500Medicaid
MN7122712OtherMEDICA
MN8768BEOtherBCBS
MNNH0248OtherUCARE
MN925385OtherUNITED HEALTH CARE
MNNH0248OtherUCARE
MN245236Medicare ID - Type Unspecified