Healthcare Provider Details

I. General information

NPI: 1477512713
Provider Name (Legal Business Name): RANGE REGIONAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 7TH AVE E
HIBBING MN
55746-3553
US

IV. Provider business mailing address

3520 7TH AVE E
HIBBING MN
55746-3553
US

V. Phone/Fax

Practice location:
  • Phone: 218-262-5139
  • Fax: 218-263-4050
Mailing address:
  • Phone: 218-262-5139
  • Fax: 218-263-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number329455
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number329458
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number329550
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number329456
License Number StateMN

VIII. Authorized Official

Name: MR. JOHN KRITZ
Title or Position: SR VICE PRESIDENT/CFO
Credential:
Phone: 218-362-6657