Healthcare Provider Details

I. General information

NPI: 1407843691
Provider Name (Legal Business Name): PERHAM HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 3RD STREET SW
PERHAM MN
56573-1108
US

IV. Provider business mailing address

735 3RD STREET SW
PERHAM MN
56573-1108
US

V. Phone/Fax

Practice location:
  • Phone: 218-347-1880
  • Fax: 218-347-1885
Mailing address:
  • Phone: 218-347-1880
  • Fax: 218-347-1885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHFID - 03870
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUSTINE ANDERSON
Title or Position: VP OF FINANCE
Credential:
Phone: 218-347-1306