Provider Demographics
NPI:1063511020
Name:NORTHERN PINES MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTHERN PINES MEDICAL CENTER
Other - Org Name:ESSENTIA HEALTH NORTHERN PINES CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-786-1009
Mailing Address - Street 1:5211 HIGHWAY 110
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MN
Mailing Address - Zip Code:55705-1522
Mailing Address - Country:US
Mailing Address - Phone:218-229-2211
Mailing Address - Fax:218-229-2042
Practice Address - Street 1:5211 HIGHWAY 110
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MN
Practice Address - Zip Code:55705-1522
Practice Address - Country:US
Practice Address - Phone:218-229-2211
Practice Address - Fax:218-229-2042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1063511020Medicaid
MN1063511020Medicaid