Organization
VILLA ST. VINCENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY HULST (CEO/ADMINISTRATOR)
(218) 281-9700
Entity
Organization
Contact information
Practice address
516 WALSH ST, CROOKSTON, MN 56716
(218) 281-3424
(218) 281-4755
Mailing address
516 WALSH ST, CROOKSTON, MN 56716
(218) 281-3424
(218) 281-4755
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
325662
MN
310400000X
Assisted Living Facility
353890
MN
314000000X
Skilled Nursing Facility
328575
MN
314000000X
Skilled Nursing Facility
352789
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177240600
—
MN
01
—
8756VI
BLUE CROSS INSURANCE
MN
Enumeration date
06/21/2005
Last updated
10/23/2013
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