Provider Demographics
NPI:1336300326
Name:KITTSON MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:KITTSON MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:RIVER'S EDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JENI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWENZFEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-843-3802
Mailing Address - Street 1:513 10TH STREET SE
Mailing Address - Street 2:
Mailing Address - City:HALLOCK
Mailing Address - State:MN
Mailing Address - Zip Code:56728
Mailing Address - Country:US
Mailing Address - Phone:218-843-8812
Mailing Address - Fax:218-843-2487
Practice Address - Street 1:1010 S BIRCH AVE
Practice Address - Street 2:
Practice Address - City:HALLOCK
Practice Address - State:MN
Practice Address - Zip Code:56728
Practice Address - Country:US
Practice Address - Phone:218-843-3662
Practice Address - Fax:218-843-2487
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KITTSON MEMORIAL HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-23
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN337988310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility