Provider Demographics
NPI:1942233234
Name:MAHNOMEN HEALTH CENTER
Entity Type:Organization
Organization Name:MAHNOMEN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUENTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-935-9401
Mailing Address - Street 1:414 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MAHNOMEN
Mailing Address - State:MN
Mailing Address - Zip Code:56557-4912
Mailing Address - Country:US
Mailing Address - Phone:218-935-2511
Mailing Address - Fax:218-935-2370
Practice Address - Street 1:414 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MAHNOMEN
Practice Address - State:MN
Practice Address - Zip Code:56557-4912
Practice Address - Country:US
Practice Address - Phone:218-935-2511
Practice Address - Fax:218-935-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN365335282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND02005Medicaid
MN0C16HMAOtherBCBS
MN739745300Medicaid
MN5025338OtherMEDICA
MN284545900OtherDEPARTMENT OF LABOR
MN241300OtherMEDICARE PTAN