Provider Demographics
NPI:1730256207
Name:WELCOV HEALTHCARE LLC
Entity type:Organization
Organization Name:WELCOV HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-873-7934
Mailing Address - Street 1:2801 S HIGHWAY 169
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-9552
Mailing Address - Country:US
Mailing Address - Phone:218-326-3431
Mailing Address - Fax:218-327-3217
Practice Address - Street 1:2801 S HIGHWAY 169
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-9552
Practice Address - Country:US
Practice Address - Phone:218-326-3431
Practice Address - Fax:218-327-3217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331604314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN606318700Medicaid
MN606318700Medicaid