Healthcare Provider Details

I. General information

NPI: 1093766388
Provider Name (Legal Business Name): GGNSC HIBBING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2413 1ST AVE
HIBBING MN
55746-2101
US

IV. Provider business mailing address

2413 1ST AVE
HIBBING MN
55746-2101
US

V. Phone/Fax

Practice location:
  • Phone: 218-262-1081
  • Fax: 218-262-4976
Mailing address:
  • Phone: 218-262-1081
  • Fax: 218-262-4976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number332031
License Number StateMN

VIII. Authorized Official

Name: HOLLY A. RASMUSSEN-JONES
Title or Position: SECRETARY
Credential:
Phone: 479-201-4835