Provider Demographics
NPI:1790842466
Name:SANFORD HEALTH NETWORK NORTH
Entity Type:Organization
Organization Name:SANFORD HEALTH NETWORK NORTH
Other - Org Name:SANFORD HEALTH NORTHERN LIGHTS RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-328-8380
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:053-286-5856
Mailing Address - Fax:
Practice Address - Street 1:921 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-1638
Practice Address - Country:US
Practice Address - Phone:218-681-8706
Practice Address - Fax:218-681-2816
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANFORD HEALTH NETWORK NORTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-02
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251B00000X, 251C00000X, 261QM0855X, 273R00000X
MNFBL-18326-12117261QM0850X
MN107543-1-CDT276400000X
283Q00000X
MN350301322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No273R00000XHospital UnitsPsychiatric Unit
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN731047101Medicaid
MN221959000Medicaid
MN731047103Medicaid
MN731047102Medicaid
MN731047102Medicaid