Healthcare Provider Details

I. General information

NPI: 1396737417
Provider Name (Legal Business Name): EVELETH HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MCKINLEY AVE
EVELETH MN
55734-1606
US

IV. Provider business mailing address

227 MCKINLEY AVE
EVELETH MN
55734-1606
US

V. Phone/Fax

Practice location:
  • Phone: 218-744-1950
  • Fax: 218-744-3868
Mailing address:
  • Phone: 218-744-1950
  • Fax: 218-744-3868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES Q FORSMAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 218-744-1950