Provider Demographics
NPI:1932368313
Name:RANGE MENTAL HEALTH CENTER INC
Entity Type:Organization
Organization Name:RANGE MENTAL HEALTH CENTER INC
Other - Org Name:MERRITT HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, LP
Authorized Official - Phone:218-749-2881
Mailing Address - Street 1:PO BOX 1188
Mailing Address - Street 2:624 S 13TH ST
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792
Mailing Address - Country:US
Mailing Address - Phone:218-749-2881
Mailing Address - Fax:218-749-3806
Practice Address - Street 1:731 3RD ST S
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792
Practice Address - Country:US
Practice Address - Phone:218-741-9630
Practice Address - Fax:218-741-2640
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RANGE MENTAL HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-02
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness