Provider Demographics
NPI:1831256320
Name:CENTRACARE HEALTH SYSTEM-NR LLC
Entity type:Organization
Organization Name:CENTRACARE HEALTH SYSTEM-NR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LECHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-271-2251
Mailing Address - Street 1:1013 HART BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8575
Mailing Address - Country:US
Mailing Address - Phone:763-271-2251
Mailing Address - Fax:763-271-2346
Practice Address - Street 1:1013 HART BLVD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8575
Practice Address - Country:US
Practice Address - Phone:763-271-2251
Practice Address - Fax:763-271-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MN2640793336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145661OtherPK
MN2411471Medicare UPIN
MN155047100Medicaid