Healthcare Provider Details

I. General information

NPI: 1316026370
Provider Name (Legal Business Name): HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 EAST LINCOLN STREET
HENDRICKS MN
56136-0106
US

IV. Provider business mailing address

PO BOX 106 503 EAST LINCOLN STREET
HENDRICKS MN
56136-0106
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number330907
License Number StateMN

VIII. Authorized Official

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