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General NPI Number Information
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NPI Number | 1710924428
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Entity Type | Organization
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Legal Business Name | COMMUNITY MEMORIAL HOSPITAL ASSOCIATION
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 09/05/2007
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Provider Practice Location Address
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Address Line | 512 SKYLINE BLVD
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City | CLOQUET
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State | MN
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Zip | 55720-3787
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Country | US
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Telephone | 218-879-4641
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Fax | 218-879-3237
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Provider Business Mailing Address
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Address Line | 512 SKYLINE BLVD
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City | CLOQUET
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State | MN
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Zip | 55720-3787
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Country | US
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Telephone | 218-879-4641
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Fax | 218-879-3237
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | MR. RICHARD L. BREUER
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Credential |
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Telephone | 218-878-7621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | MN331132
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License Number State | MN
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