Provider Demographics
NPI:1700057064
Name:DEERFIELD CARE CENTER, LLC
Entity Type:Organization
Organization Name:DEERFIELD CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-631-6120
Mailing Address - Street 1:2845 HAMLINE AVE N
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-7127
Mailing Address - Country:US
Mailing Address - Phone:651-631-6120
Mailing Address - Fax:651-631-6115
Practice Address - Street 1:505 W 8TH ST
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1524
Practice Address - Country:US
Practice Address - Phone:651-631-6120
Practice Address - Fax:651-631-6115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHM/ NEW RICHMOND SENIOR HOUSING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-14
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WINH0621OtherUCARE
WI525019Medicare Oscar/Certification