Provider Demographics
NPI:1619665379
Name:WHITE IRON BEHAVIORAL HEALTH SERVICES, PLC
Entity Type:Organization
Organization Name:WHITE IRON BEHAVIORAL HEALTH SERVICES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:KERN
Authorized Official - Last Name:UDOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:218-235-1108
Mailing Address - Street 1:507 E HARVEY ST
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-1445
Mailing Address - Country:US
Mailing Address - Phone:218-235-1108
Mailing Address - Fax:
Practice Address - Street 1:21 E CHAPMAN ST
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-1227
Practice Address - Country:US
Practice Address - Phone:218-235-1108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)