Provider Demographics
NPI:1013206812
Name:HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME
Entity Type:Organization
Organization Name:HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME
Other - Org Name:HENDRICKS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLAHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-275-3134
Mailing Address - Street 1:501 E LINCOLN ST
Mailing Address - Street 2:PO BOX 106
Mailing Address - City:HENDRICKS
Mailing Address - State:MN
Mailing Address - Zip Code:56136-9598
Mailing Address - Country:US
Mailing Address - Phone:507-275-3134
Mailing Address - Fax:507-275-2242
Practice Address - Street 1:501 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:HENDRICKS
Practice Address - State:MN
Practice Address - Zip Code:56136-9598
Practice Address - Country:US
Practice Address - Phone:507-275-3121
Practice Address - Fax:507-275-3194
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENDRICKS COMMUNITY HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-01
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN243455Medicare Oscar/Certification