Healthcare Provider Details

I. General information

NPI: 1558435131
Provider Name (Legal Business Name): GRAND ITASCA CLINIC AND HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SE 3RD ST
GRAND RAPIDS MN
55744-3663
US

IV. Provider business mailing address

1601 GOLF COURSE RD
GRAND RAPIDS MN
55744-8648
US

V. Phone/Fax

Practice location:
  • Phone: 218-999-1055
  • Fax: 218-999-1052
Mailing address:
  • Phone: 218-999-1055
  • Fax: 218-999-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JEAN MACDONELL
Title or Position: COO
Credential:
Phone: 218-999-1510