Provider Demographics
NPI:1245576073
Name:GPH BELTRAMI INC
Entity Type:Organization
Organization Name:GPH BELTRAMI INC
Other - Org Name:GOLDPINE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-444-4346
Mailing Address - Street 1:1700 30TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-5608
Mailing Address - Country:US
Mailing Address - Phone:218-444-4346
Mailing Address - Fax:218-444-4083
Practice Address - Street 1:1700 30TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5608
Practice Address - Country:US
Practice Address - Phone:218-444-4346
Practice Address - Fax:218-444-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility