Provider Demographics
NPI:1407998289
Name:LITTLEFORK MUNICIPAL HOSPITAL
Entity Type:Organization
Organization Name:LITTLEFORK MUNICIPAL HOSPITAL
Other - Org Name:PINEVIEW RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD OF DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-278-4245
Mailing Address - Street 1:912 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLEFORK
Mailing Address - State:MN
Mailing Address - Zip Code:56653-9357
Mailing Address - Country:US
Mailing Address - Phone:218-278-6634
Mailing Address - Fax:218-278-6637
Practice Address - Street 1:912 MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLEFORK
Practice Address - State:MN
Practice Address - Zip Code:56653-9357
Practice Address - Country:US
Practice Address - Phone:218-278-6634
Practice Address - Fax:218-278-6637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10338271DS324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C59PIOtherBC BS MINNESOTA DETOX
MN111165OtherUCARE DETOX
MN50-21348OtherMEDICA DETOX