- Enrollment id
- O20230112000151
- Enrollment state
- MN
- Provider type code
- 00-17
- Provider type text
- PART A PROVIDER - RURAL HEALTH CLINIC
- Npi
- 1023728516
- Multiple npi flag
- N
- Ccn
- 243478
- Associate id
- 1850761685
- Organization name
- CENTRACARE HEALTH - BENSON LLC
- Doing business as name
- CENTRACARE-BENSON
- Incorporation date
- 2023-01-01
- Incorporation state
- MN
- Organization type structure
- LLC
- Proprietary nonprofit
- N
- Address line 1
- 1815 WISCONSIN AVE
- City
- BENSON
- State
- MN
- Zip code
- 562151653
- Telephone number
- 3208424232