Organization
MEMORY CARE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA L. WENNER (EXECUTIVE DIRECTOR)
(320) 257-1777
Entity
Organization
Contact information
Practice address
2835 W SAINT GERMAIN ST, SAINT CLOUD, MN 56301-6280
(320) 257-1777
(320) 257-1776
Mailing address
2835 W SAINT GERMAIN ST, P.O. BOX 7776, SAINT CLOUD, MN 56301-6280
(320) 257-1777
(320) 257-1776
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
1200898-2
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
567188400
—
MN
01
—
CO4052
MEDICARE PROVIDER GROUP NUMBER
MN
Enumeration date
08/19/2006
Last updated
10/19/2009
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