Provider Demographics
NPI:1073789269
Name:UPPER MISSISSIPPI MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:UPPER MISSISSIPPI MENTAL HEALTH CENTER, INC.
Other - Org Name:SAME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-751-3280
Mailing Address - Street 1:120 MAIN AVE N
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1810
Mailing Address - Country:US
Mailing Address - Phone:218-732-7266
Mailing Address - Fax:
Practice Address - Street 1:120 MAIN AVE N
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1810
Practice Address - Country:US
Practice Address - Phone:218-732-7266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1015165-1-CDT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN064997000OtherCONSOLIDATED FUNDING