Provider Demographics
NPI:1639237746
Name:POLINSKY MEDICAL REHABILITATION CENTER
Entity Type:Organization
Organization Name:POLINSKY MEDICAL REHABILITATION CENTER
Other - Org Name:ESSENTIA HEALTH POLINSKY MEDICAL REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-786-1009
Mailing Address - Street 1:1600 MILLER TRUNK HWY BLDG C
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-5640
Mailing Address - Country:US
Mailing Address - Phone:218-786-5360
Mailing Address - Fax:
Practice Address - Street 1:1600 MILLER TRUNK HWY BLDG C
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-5640
Practice Address - Country:US
Practice Address - Phone:218-786-5360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-04
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1639237746Medicaid
MN1639237746Medicaid
MN1639237746Medicaid
WI1639237746Medicaid
MNH100233774Medicare PIN