Provider Demographics
NPI:1053393777
Name:RED WING HEALTH CENTER, LLC
Entity type:Organization
Organization Name:RED WING HEALTH CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONTRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-730-1573
Mailing Address - Street 1:1412 WEST 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55046
Mailing Address - Country:US
Mailing Address - Phone:651-388-2843
Mailing Address - Fax:651-388-9502
Practice Address - Street 1:1412 WEST 4TH STREET
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55046
Practice Address - Country:US
Practice Address - Phone:651-388-2843
Practice Address - Fax:651-388-9502
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSION HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-17
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN329002314000000X
MN349026314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30395Medicaid
MN005315500Medicaid
MN955270700Medicaid
MN955270700Medicaid