Organization
AUGUSTANA MERCY CARE CENTER LLC
Active
Other names
Moose Lake Village
Organization subpart
No
Provider details
NPI number
Authorized official
SEELOCHANI STADTHERR (ASSOCIATE VP OF REVENUE CYCLE MGMT)
(952) 855-5041
Entity
Organization
Contact information
Practice address
710 S KENWOOD AVE, MOOSE LAKE, MN 55767-9405
(218) 485-4481
Mailing address
710 S KENWOOD AVE, MOOSE LAKE, MN 55767-9405
(218) 485-4481
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
349655
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
857637200
—
MN
Enumeration date
04/19/2010
Last updated
11/21/2025
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