Organization
MIDWAY CARE CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALLEN POTVIN (PRESIDENT)
(218) 435-6205
Entity
Organization
Contact information
Practice address
114 2ND ST NE, FOSSTON, MN 56542-1302
(218) 435-1272
(218) 435-6336
Mailing address
114 2ND ST NE, FOSSTON, MN 56542-1302
(218) 435-1272
(218) 435-6336
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
331269
MN
314000000X
Skilled Nursing Facility
Primary
331928
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
298242100
—
MN
01
—
7180017
MEDICA
MN
01
—
9457MI
BLUE CROSS
MN
Enumeration date
07/08/2006
Last updated
10/29/2009
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