Healthcare Provider Details

I. General information

NPI: 1659455897
Provider Name (Legal Business Name): ELY-BLOOMENSON COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 W CONAN ST
ELY MN
55731-1145
US

IV. Provider business mailing address

328 W CONAN ST
ELY MN
55731-1145
US

V. Phone/Fax

Practice location:
  • Phone: 218-365-3271
  • Fax:
Mailing address:
  • Phone: 218-365-3271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number381970
License Number StateMN

VIII. Authorized Official

Name: PATRICIA J BANKS
Title or Position: QUALITY HEALTH MANAGMENET OFFICER
Credential:
Phone: 218-365-8765