Provider Demographics
NPI:1316026370
Name:HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME
Entity Type:Organization
Organization Name:HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLAHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-275-3134
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:503 EAST LINCOLN STREET
Mailing Address - City:HENDRICKS
Mailing Address - State:MN
Mailing Address - Zip Code:56136-0106
Mailing Address - Country:US
Mailing Address - Phone:507-275-3134
Mailing Address - Fax:507-275-2242
Practice Address - Street 1:503 EAST LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:HENDRICKS
Practice Address - State:MN
Practice Address - Zip Code:56136-0106
Practice Address - Country:US
Practice Address - Phone:507-275-3134
Practice Address - Fax:507-275-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330907282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN549345500Medicaid
24-1339Medicare Oscar/Certification