Healthcare Provider Details

I. General information

NPI: 1598163503
Provider Name (Legal Business Name): GREATER MINNESOTA COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 30TH AVE S STE 102
MOORHEAD MN
56560-5000
US

IV. Provider business mailing address

819 30TH AVE S STE 102
MOORHEAD MN
56560-5000
US

V. Phone/Fax

Practice location:
  • Phone: 218-979-3560
  • Fax: 321-284-1080
Mailing address:
  • Phone: 218-979-3560
  • Fax: 321-284-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1078038
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN L ERIE
Title or Position: CEO
Credential:
Phone: 218-979-3560