Welcov Healthcare LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

331604 Issued in MN

Legal business name

WELCOV HEALTHCARE LLC

Doing business as

Evergreen Terrace Healthcare Community

Practice address

2801 S Highway 169
Grand Rapids, MN 55744-9552

Phone

(218) 326-3431

Fax

(218) 327-3217

NPI assigned

Nov 29, 2006

Last updated

May 1, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christine Dols

Title

Director of Managed Care

Phone

(952) 873-7934

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Evergreen Terrace Healthcare Community Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430438400000",
    "number": "1730256207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 S HIGHWAY 169",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557449552",
            "telephone_number": "218-326-3431",
            "fax_number": "218-327-3217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 S HIGHWAY 169",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557449552",
            "telephone_number": "218-326-3431",
            "fax_number": "218-327-3217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELCOV HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2015-05-01",
        "status": "A",
        "authorized_official_last_name": "DOLS",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE",
        "authorized_official_telephone_number": "952-873-7934"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "331604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "606318700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Terrace Healthcare Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.