Healthcare Provider Details

I. General information

NPI: 1518929934
Provider Name (Legal Business Name): ST MARY'S REGIONAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W 2ND ST
GRACEVILLE MN
56240-4845
US

IV. Provider business mailing address

114 FRAZEE ST E
DETROIT LAKES MN
56501-3502
US

V. Phone/Fax

Practice location:
  • Phone: 320-748-8211
  • Fax: 320-748-8247
Mailing address:
  • Phone: 218-847-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number330467
License Number StateMN

VIII. Authorized Official

Name: AL HURLEY
Title or Position: COO
Credential:
Phone: 701-364-7667