Provider Demographics
NPI:1548291404
Name:CLARKFIELD CARE CENTER
Entity type:Organization
Organization Name:CLARKFIELD CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EHRENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-669-7561
Mailing Address - Street 1:805 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:56223-1348
Mailing Address - Country:US
Mailing Address - Phone:320-669-7561
Mailing Address - Fax:320-669-7409
Practice Address - Street 1:805 5TH ST
Practice Address - Street 2:
Practice Address - City:CLARKFIELD
Practice Address - State:MN
Practice Address - Zip Code:56223-1348
Practice Address - Country:US
Practice Address - Phone:320-669-7561
Practice Address - Fax:320-669-7409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331614314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24-5551OtherMEDICARE
MN908340500Medicaid
MN4544CLOtherBC
MNNH0290OtherUCARE