Provider Demographics
NPI:1538165030
Name:ST. MARYS SENIOR LIVING CENTER OF WINSTED
Entity type:Organization
Organization Name:ST. MARYS SENIOR LIVING CENTER OF WINSTED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:OPSAHL
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:320-485-3130
Mailing Address - Street 1:PO BOX 750
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:MN
Mailing Address - Zip Code:55395-0750
Mailing Address - Country:US
Mailing Address - Phone:320-485-2151
Mailing Address - Fax:
Practice Address - Street 1:551 FOURTH ST N
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:MN
Practice Address - Zip Code:55395
Practice Address - Country:US
Practice Address - Phone:320-485-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328589314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
245459Medicare ID - Type Unspecified