Provider Demographics
NPI:1871610113
Name:STEWARTVILLE NURSING HOME, INC.
Entity type:Organization
Organization Name:STEWARTVILLE NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-533-4288
Mailing Address - Street 1:120 4TH ST NE
Mailing Address - Street 2:
Mailing Address - City:STEWARTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55976-1212
Mailing Address - Country:US
Mailing Address - Phone:507-533-4288
Mailing Address - Fax:507-533-1384
Practice Address - Street 1:120 4TH ST NE
Practice Address - Street 2:
Practice Address - City:STEWARTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55976-1212
Practice Address - Country:US
Practice Address - Phone:507-533-4288
Practice Address - Fax:507-533-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN332716314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNH0549OtherUCARE
MN8787STOtherBLUE CROSS BLUE SHIELD
MN245349Medicare ID - Type Unspecified