Healthcare Provider Details

I. General information

NPI: 1578553160
Provider Name (Legal Business Name): ST MARYS REGIONAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 LINCOLN AVE
DETROIT LAKES MN
56501-3409
US

IV. Provider business mailing address

1040 LINCOLN AVE
DETROIT LAKES MN
56501-3409
US

V. Phone/Fax

Practice location:
  • Phone: 218-847-0820
  • Fax: 218-844-0780
Mailing address:
  • Phone: 218-847-0820
  • Fax: 218-844-0780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number328815
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number354804
License Number StateMN

VIII. Authorized Official

Name: ALAN JAMES HURLEY
Title or Position: COO
Credential:
Phone: 979-820-4247