Healthcare Provider Details

I. General information

NPI: 1508814575
Provider Name (Legal Business Name): CHISHOLM HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 6TH ST NE
CHISHOLM MN
55719-1287
US

IV. Provider business mailing address

801 NEVADA AVE
MORRIS MN
56267-1865
US

V. Phone/Fax

Practice location:
  • Phone: 218-254-5765
  • Fax: 218-254-5767
Mailing address:
  • Phone: 320-589-2004
  • Fax: 320-589-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number328696
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierNH0563
Identifier TypeOTHER
Identifier State
Identifier IssuerUCARE
# 2
Identifier7122706
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICA
# 3
Identifier936651200
Identifier TypeMEDICAID
Identifier StateMN
Identifier Issuer
# 4
Identifier9605HE
Identifier TypeOTHER
Identifier State
Identifier IssuerBCBS
# 5
Identifier140017
Identifier TypeOTHER
Identifier State
Identifier IssuerFIRST PLAN

VIII. Authorized Official

Name: CURTIS BACH
Title or Position: CFO
Credential:
Phone: 320-589-4910