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General NPI Number Information
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NPI Number | 1700955366
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Entity Type | Organization
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Legal Business Name | GEROPSYCH HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 611 SPRUCE GROVE LN NW
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City | BEMIDJI
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State | MN
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Zip | 56601-7746
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Country | US
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Telephone | 218-209-1137
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Fax | 218-333-0335
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Provider Business Mailing Address
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Address Line | 611 SPRUCE GROVE LN NW P.O. BOX 155
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City | BEMIDJI
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State | MN
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Zip | 56601-7746
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Country | US
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Telephone | 218-209-1137
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Fax | 218-333-0335
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Authorized Official
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Title or Position | OWNER
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Name | MS. SAUNDA M ST. MARTIN
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Credential | NP-CNS
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Telephone | 218-209-1137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | R1077485
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License Number State | MN
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