1124025812 NPI number — COMMUNITY MEMORIAL HOSPITAL & NURSING HOME

Table of content: (NPI 1124025812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124025812 NPI number — COMMUNITY MEMORIAL HOSPITAL & NURSING HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY MEMORIAL HOSPITAL & NURSING HOME
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SPRING VALLEY SENIOR LIVING
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124025812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 MEMORIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55975-1024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-346-7381
Provider Business Mailing Address Fax Number:
507-346-7619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55975-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-346-7381
Provider Business Practice Location Address Fax Number:
507-346-7619
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SOLBERG
Authorized Official First Name:
PENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
507-346-7381

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7Z16SP . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: NH0282 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 046545300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5C61SP . This is a "BCBS HOME HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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