Provider Demographics
NPI:1972506335
Name:BELGRADE NURSING HOME
Entity Type:Organization
Organization Name:BELGRADE NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-254-8215
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MN
Mailing Address - Zip Code:56312-0340
Mailing Address - Country:US
Mailing Address - Phone:320-254-8215
Mailing Address - Fax:320-254-8238
Practice Address - Street 1:103 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MN
Practice Address - Zip Code:56312
Practice Address - Country:US
Practice Address - Phone:320-254-8215
Practice Address - Fax:320-254-8238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9398975314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN901743700Medicaid