Healthcare Provider Details

I. General information

NPI: 1710954821
Provider Name (Legal Business Name): RANGE REGIONAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 CRESCENT DRIVE SUITE 1
INTERNATIONAL FALLS MN
56649-2198
US

IV. Provider business mailing address

1101 EAST 37TH STREET SUITE 18
GIBBING MN
55746-2973
US

V. Phone/Fax

Practice location:
  • Phone: 218-283-4174
  • Fax: 218-283-5561
Mailing address:
  • Phone: 218-262-6981
  • Fax: 218-262-5756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DEBRA KATHLEEN BOARDMAN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 218-362-6730