Healthcare Provider Details

I. General information

NPI: 1710912787
Provider Name (Legal Business Name): MAHNOMEN HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 W JEFFERSON AVE
MAHNOMEN MN
56557-4912
US

IV. Provider business mailing address

414 W JEFFERSON AVE
MAHNOMEN MN
56557-4912
US

V. Phone/Fax

Practice location:
  • Phone: 218-935-2511
  • Fax: 218-935-2370
Mailing address:
  • Phone: 218-935-2511
  • Fax: 218-935-2370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number372204
License Number StateMN

VIII. Authorized Official

Name: LORI GUENTHER
Title or Position: CFO
Credential:
Phone: 218-935-9401