Healthcare Provider Details

I. General information

NPI: 1205929981
Provider Name (Legal Business Name): MINNESOTA NEUROREHABILITAION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11615 STATE AVE
BRAINERD MN
56401-7306
US

IV. Provider business mailing address

PO BOX 64979
SAINT PAUL MN
55164-0979
US

V. Phone/Fax

Practice location:
  • Phone: 218-828-2718
  • Fax:
Mailing address:
  • Phone: 651-431-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUG V. SEILER
Title or Position: SPECIAL POPULATIONS ADMINISTRATOR
Credential:
Phone: 218-739-7224