Provider Demographics
NPI:1902808249
Name:ST. CLOUD HOSPITAL
Entity Type:Organization
Organization Name:ST. CLOUD HOSPITAL
Other - Org Name:ST. BENEDICT'S SENIOR COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR BUSINESS
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIDAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-252-0010
Mailing Address - Street 1:1810 MINNESOTA BLVD SE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56304
Mailing Address - Country:US
Mailing Address - Phone:320-252-0010
Mailing Address - Fax:320-203-2738
Practice Address - Street 1:1810 MINNESOTA BLVD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-2436
Practice Address - Country:US
Practice Address - Phone:320-252-0010
Practice Address - Fax:320-252-8611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5359694314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN885740700Medicaid
MN885740700Medicaid