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General NPI Number Information
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NPI Number | 1194014134
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Entity Type | Organization
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Legal Business Name | MINNESOTA SPECIALITY HEALTH SYSTEMS WILLMAR
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 1208 OLENA AVE. SE
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City | WILLMAR
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State | MN
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Zip | 56201
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Country | US
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Telephone | 320-235-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 LABORE RD SUITE 104
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55110-5186
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Country | US
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Telephone | 651-539-7200
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Fax | 651-431-7505
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | LYNN GLANCEY
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Credential |
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Telephone | 651-539-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 1058767-1-RMI
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License Number State | MN
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