Healthcare Provider Details

I. General information

NPI: 1073516357
Provider Name (Legal Business Name): WARREN COMMUNITY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W GOOD SAMARITAN DR
WARREN MN
56762-1412
US

IV. Provider business mailing address

300 W GOOD SAMARITAN DR
WARREN MN
56762-1412
US

V. Phone/Fax

Practice location:
  • Phone: 218-745-4211
  • Fax: 218-745-4215
Mailing address:
  • Phone: 218-745-4211
  • Fax: 218-745-4215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number327602
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number327602
License Number StateMN

VIII. Authorized Official

Name: MR. JON E LINNELL
Title or Position: CEO
Credential:
Phone: 218-745-4211