Provider Demographics
NPI:1841617172
Name:RED WING HEALTH CENTER
Entity Type:Organization
Organization Name:RED WING HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-385-4804
Mailing Address - Street 1:1412 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2107
Mailing Address - Country:US
Mailing Address - Phone:651-385-4804
Mailing Address - Fax:651-385-0967
Practice Address - Street 1:1412 W 4TH ST
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2107
Practice Address - Country:US
Practice Address - Phone:651-385-4804
Practice Address - Fax:651-385-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty