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General NPI Number Information
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NPI Number | 1639232663
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Entity Type | Organization
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Legal Business Name | RANGE MENTAL HEALTH CENTER INC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 3203 W 3RD AVE
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City | HIBBING
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State | MN
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Zip | 55746
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Country | US
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Telephone | 218-263-9237
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Fax | 218-262-3150
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Provider Business Mailing Address
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Address Line | 624 S 13TH ST
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City | VIRGINIA
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State | MN
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Zip | 55792
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Country | US
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Telephone | 218-749-2881
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Fax | 218-749-3806
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MARY J CARPENTER
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Credential | MSED, LP
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Telephone | 218-749-2881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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