Provider Demographics
NPI:1073516357
Name:WARREN COMMUNITY HOSPITAL, INC.
Entity Type:Organization
Organization Name:WARREN COMMUNITY HOSPITAL, INC.
Other - Org Name:NORTH VALLEY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:E
Authorized Official - Last Name:LINNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-745-4211
Mailing Address - Street 1:300 W GOOD SAMARITAN DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MN
Mailing Address - Zip Code:56762-1412
Mailing Address - Country:US
Mailing Address - Phone:218-745-4211
Mailing Address - Fax:218-745-4215
Practice Address - Street 1:300 W GOOD SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MN
Practice Address - Zip Code:56762-1412
Practice Address - Country:US
Practice Address - Phone:218-745-4211
Practice Address - Fax:218-745-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327602261Q00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN039845400Medicaid
MN93752500Medicaid
MNC06569Medicare Oscar/Certification
MN241337Medicare Oscar/Certification
MN243409Medicare Oscar/Certification
MN24Z337Medicare Oscar/Certification
MN039845400Medicaid