Provider Demographics
NPI:1518929934
Name:ST MARY'S REGIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:ST MARY'S REGIONAL HEALTH CENTER
Other - Org Name:ESSENTIA HEALTH HOME CARE GRACEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-364-7667
Mailing Address - Street 1:114 FRAZEE ST E
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3502
Mailing Address - Country:US
Mailing Address - Phone:218-847-0808
Mailing Address - Fax:
Practice Address - Street 1:115 W 2ND ST
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:MN
Practice Address - Zip Code:56240-4845
Practice Address - Country:US
Practice Address - Phone:320-748-8211
Practice Address - Fax:320-748-8247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-03
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330467251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN854545600Medicaid
MN248045Medicare PIN