Provider Demographics
NPI:1477512713
Name:RANGE REGIONAL HEALTH SERVICES
Entity Type:Organization
Organization Name:RANGE REGIONAL HEALTH SERVICES
Other - Org Name:GREENVIEW ALZHEIMER'S RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-362-6657
Mailing Address - Street 1:3520 7TH AVE E
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3553
Mailing Address - Country:US
Mailing Address - Phone:218-262-5139
Mailing Address - Fax:218-263-4050
Practice Address - Street 1:3520 7TH AVE E
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-3553
Practice Address - Country:US
Practice Address - Phone:218-262-5139
Practice Address - Fax:218-263-4050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RANGE REGIONAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-23
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN329456311500000X
MN329455311500000X
MN329458311500000X
MN329550311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN008718100Medicaid
MN4980623OtherMEDICA
MNAL0210OtherUCARE