Provider Demographics
NPI:1598163503
Name:GREATER MINNESOTA COMMUNITY SERVICES
Entity Type:Organization
Organization Name:GREATER MINNESOTA COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ERIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-979-3560
Mailing Address - Street 1:819 30TH AVE S STE 102
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5000
Mailing Address - Country:US
Mailing Address - Phone:218-979-3560
Mailing Address - Fax:321-284-1080
Practice Address - Street 1:819 30TH AVE S STE 102
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5000
Practice Address - Country:US
Practice Address - Phone:218-979-3560
Practice Address - Fax:321-284-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1078038261QA0600X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care