Provider Demographics
NPI:1689752800
Name:DULUTH HEALTH SERVICES
Entity Type:Organization
Organization Name:DULUTH HEALTH SERVICES
Other - Org Name:SUNCREST ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MONCRIEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-589-4910
Mailing Address - Street 1:801 NEVADA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267-1874
Mailing Address - Country:US
Mailing Address - Phone:320-589-2004
Mailing Address - Fax:320-589-2543
Practice Address - Street 1:2400 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720
Practice Address - Country:US
Practice Address - Phone:218-878-1180
Practice Address - Fax:218-878-1201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. FRANCIS HEALTH SERVICES OF MORRIS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-02
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN329595310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN161608100Medicaid