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General NPI Number Information
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NPI Number | 1558435131
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Entity Type | Organization
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Legal Business Name | GRAND ITASCA CLINIC AND HOSPITAL
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 111 SE 3RD ST
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City | GRAND RAPIDS
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State | MN
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Zip | 55744-3663
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Country | US
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Telephone | 218-999-1055
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Fax | 218-999-1052
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Provider Business Mailing Address
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Address Line | 1601 GOLF COURSE RD
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City | GRAND RAPIDS
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State | MN
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Zip | 55744-8648
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Country | US
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Telephone | 218-999-1055
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Fax | 218-999-1052
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Authorized Official
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Title or Position | COO
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Name | JEAN MACDONELL
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Credential |
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Telephone | 218-999-1510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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