Healthcare Provider Details

I. General information

NPI: 1588657696
Provider Name (Legal Business Name): MONTICELLO-BIG LAKE COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 E RIVER ST
MONTICELLO MN
55362-8762
US

IV. Provider business mailing address

1104 E RIVER ST
MONTICELLO MN
55362-8762
US

V. Phone/Fax

Practice location:
  • Phone: 763-295-5116
  • Fax:
Mailing address:
  • Phone: 763-295-5116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number328129
License Number StateMN

VIII. Authorized Official

Name: MRS. SANDRA PAWELK
Title or Position: DIRECTOR OF BUSINESS OFFICE
Credential:
Phone: 763-271-2306