Provider Demographics
NPI:1205929981
Name:MINNESOTA NEUROREHABILITAION HOSPITAL
Entity type:Organization
Organization Name:MINNESOTA NEUROREHABILITAION HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL POPULATIONS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:V
Authorized Official - Last Name:SEILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-739-7224
Mailing Address - Street 1:PO BOX 64979
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55164-0979
Mailing Address - Country:US
Mailing Address - Phone:651-431-3676
Mailing Address - Fax:
Practice Address - Street 1:11615 STATE AVE
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-7306
Practice Address - Country:US
Practice Address - Phone:218-828-2718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN009516800Medicaid
MN24-3025Medicare Oscar/Certification