Provider Demographics
NPI:1093810244
Name:GRATTAN HEALTH CARE INCORPORATED
Entity Type:Organization
Organization Name:GRATTAN HEALTH CARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:STACI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GRATTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-820-1326
Mailing Address - Street 1:5710 COUNTY ROAD 121
Mailing Address - Street 2:
Mailing Address - City:FORT RIPLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56449-1486
Mailing Address - Country:US
Mailing Address - Phone:218-820-1326
Mailing Address - Fax:218-825-0144
Practice Address - Street 1:5710 COUNTY ROAD 121
Practice Address - Street 2:
Practice Address - City:FORT RIPLEY
Practice Address - State:MN
Practice Address - Zip Code:56449-1486
Practice Address - Country:US
Practice Address - Phone:218-820-1326
Practice Address - Fax:218-825-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN163WA2000X, 372500000X, 3747P1801X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty
Not Answered372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Not Answered376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN164464OtherUCARE MINNESOTA
MN51M51GROtherBLUE CROSS BLUE SHIEL