Provider Demographics
NPI:1780654962
Name:GRANITE FALLS MUNICIPAL HOSPITAL AND MANOR
Entity Type:Organization
Organization Name:GRANITE FALLS MUNICIPAL HOSPITAL AND MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERLACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-564-3111
Mailing Address - Street 1:345 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56241-1442
Mailing Address - Country:US
Mailing Address - Phone:320-564-3111
Mailing Address - Fax:320-564-2329
Practice Address - Street 1:345 10TH AVE
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56241-1442
Practice Address - Country:US
Practice Address - Phone:320-564-3111
Practice Address - Fax:320-564-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8828655282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1664HGROtherBCBS OF MINNESOTA
MN1664HGROtherBCBS OF MINNESOTA