Provider Demographics
NPI:1912121484
Name:ELY BLOOMENSON COMMUNITY HOSPITAL & NURSING HOME
Entity Type:Organization
Organization Name:ELY BLOOMENSON COMMUNITY HOSPITAL & NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KATZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-365-8761
Mailing Address - Street 1:328 W CONAN STREET
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-1198
Mailing Address - Country:US
Mailing Address - Phone:218-365-3271
Mailing Address - Fax:218-365-8777
Practice Address - Street 1:328 W CONAN STREET
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-1198
Practice Address - Country:US
Practice Address - Phone:218-365-3271
Practice Address - Fax:218-365-8777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELY BLOOMENSON COMMUNITY HOSPITAL & NURSING HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-13
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2004567282NC0060X
MN327664282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN122747500Medicaid
MN241318Medicare Oscar/Certification