Provider Demographics
NPI:1720078686
Name:ST MARYS REGIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:ST MARYS REGIONAL HEALTH CENTER
Other - Org Name:ESSENTIA HEALTH HOME CARE WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-820-4247
Mailing Address - Street 1:114 FRAZEE ST E
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3502
Mailing Address - Country:US
Mailing Address - Phone:218-847-0808
Mailing Address - Fax:218-847-0850
Practice Address - Street 1:114 FRAZEE ST E
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501
Practice Address - Country:US
Practice Address - Phone:218-847-0808
Practice Address - Fax:218-847-0850
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-24
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN892442000Medicaid
MN892442000Medicaid