Healthcare Provider Details

I. General information

NPI: 1013206812
Provider Name (Legal Business Name): HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E LINCOLN ST
HENDRICKS MN
56136-9598
US

IV. Provider business mailing address

501 E LINCOLN ST PO BOX 106
HENDRICKS MN
56136-9598
US

V. Phone/Fax

Practice location:
  • Phone: 507-275-3121
  • Fax: 507-275-3194
Mailing address:
  • Phone: 507-275-3134
  • Fax: 507-275-2242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF GOLLAHER
Title or Position: CEO
Credential:
Phone: 507-275-3134