Provider Demographics
NPI:1548268105
Name:NORTHFIELD CARE CENTER, INC.
Entity type:Organization
Organization Name:NORTHFIELD CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-664-3465
Mailing Address - Street 1:900 CANNON VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-1334
Mailing Address - Country:US
Mailing Address - Phone:507-645-9511
Mailing Address - Fax:507-645-0117
Practice Address - Street 1:900 CANNON VALLEY DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-1334
Practice Address - Country:US
Practice Address - Phone:507-645-9511
Practice Address - Fax:507-645-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327811314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9502NOOtherBLUE CROSS BLUE SHIELD
MN080543200Medicaid
MN080543200Medicaid