Healthcare Provider Details

I. General information

NPI: 1740202308
Provider Name (Legal Business Name): NAYTAHWAUSH HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2471 310TH AVE
MAHNOMEN MN
56557-9393
US

IV. Provider business mailing address

2471 310TH AVE
MAHNOMEN MN
56557-9393
US

V. Phone/Fax

Practice location:
  • Phone: 218-935-2238
  • Fax: 218-935-5085
Mailing address:
  • Phone: 218-935-2238
  • Fax: 218-935-5085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOCELYN JACKSON
Title or Position: ADMINISTRATIVE OFFICER
Credential:
Phone: 218-983-4300