Provider Demographics
NPI:1013940758
Name:KELLIHER CARE CENTER INC.
Entity Type:Organization
Organization Name:KELLIHER CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDNET
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-435-6205
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:KELLIHER
Mailing Address - State:MN
Mailing Address - Zip Code:56650-0189
Mailing Address - Country:US
Mailing Address - Phone:218-647-8258
Mailing Address - Fax:218-647-8483
Practice Address - Street 1:312 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KELLIHER
Practice Address - State:MN
Practice Address - Zip Code:56650-0189
Practice Address - Country:US
Practice Address - Phone:218-647-8258
Practice Address - Fax:218-647-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328687314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7189753OtherMEDICA
MN8575KEOtherBLUE CROSS OF MN
MN245543Medicare ID - Type Unspecified