MINNESOTA SPECIALITY HEALTH SYSTEMS WILLMAR - NPI NUMBER 1194014134

Summary

Provider Name: MINNESOTA SPECIALITY HEALTH SYSTEMS WILLMAR

NPI Number: 1194014134

Clasification: Community Based Residential Treatment Facility, Mental Illness (320800000X)

Address:
1208 OLENA AVE
WILLMAR, MN
ZIP 56201

Phone Number: (651) 431-3676



Detailed Information

MINNESOTA SPECIALITY HEALTH SYSTEMS WILLMAR is a community based residential treatment facility, mental illness in Willmar, MN. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. The assigned NPI number for this provider is 1194014134 and is registered as an organization entity type.

The provider's business address is:

1208 OLENA AVE
WILLMAR, MN
ZIP 56201-766
Phone: (651) 431-3676
Fax: (651) 431-7505

The provider's authorized official is Lori A Zook .
The authorized official title is Controller and has the following contact phone number (651) 431-3691.

The enumeration date for this NPI number is 3/30/2011 and was last updated on 3/30/2011.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 320800000X Community Based Residential Treatment Facility, Mental Illness 1058767-1-RMI MN Yes

NPI Record

No. Field Name Field Value
1 NPI 1194014134
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name MINNESOTA SPECIALITY HEALTH SYSTEMS WILLMAR
5 Provider First Line Business Practice Location Address 1208 OLENA AVE
6 Provider Business Practice Location Address City Name WILLMAR
7 Provider Business Practice Location Address State Name MN
8 Provider Business Practice Location Address Postal Code 562014766
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 6514313676
11 Provider Business Practice Location Address Fax Number 6514317505
12 Provider Enumeration Date 3/30/2011
13 Last Update Date 3/30/2011
14 Authorized Official Last Name ZOOK
15 Authorized Official First Name LORI
16 Authorized Official Middle Name A
17 Authorized Official Title or Position CONTROLLER
18 Authorized Official Telephone Number 6514313691
19 Healthcare Provider Taxonomy Code 1 320800000X
20 Provider License Number 1 1058767-1-RMI
21 Provider License Number State Code 1 MN
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Is Organization Subpart N
24 Authorized Official Name Prefix Text MS.

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This page was last updated on: 9/11/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.