Organization
INTER-FAITH CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY C PENK (ADMINISTRATOR)
(218) 384-8411
Entity
Organization
Contact information
Practice address
811 3RD ST, CARLTON, MN 55718-9228
(218) 384-4258
(218) 384-9820
Mailing address
811 3RD ST, CARLTON, MN 55718-9228
(218) 384-4258
(218) 384-9820
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
328756
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9753CA
BLUE CROSS & BLUE SHIELD
MN
Enumeration date
06/21/2005
Last updated
07/18/2007
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