SANFORD HEALTH OF NORTHERN MINNESOTA (NPI# 1093278764) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093278764 |
| Entity Type | Organization |
| Organization Name | SANFORD HEALTH OF NORTHERN MINNESOTA |
| Other Organization Name | SANFORD HEALTH PRIMEWEST RESIDENTIAL SUPPORT CENTER |
| Practice Address |
3124 Hannah Ave Nw Bemidji MN 56601-5625 |
| Mailing Address |
Po Box 5074 Sioux Falls SD 57117-5074 |
| Practice Telephone | 2183332300 |
| Practice Fax Number | 2183330317 |
| Mailing Telephone | 6053286585 |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2020-06-26 |
| Authorized Official Name | TONY LEE MORRISON (VICE PRESIDENT, REVENUE CYCLE) |
| Authorized Official Telephone | 6053288380 |
| Is Organization Subpart | Y |
| Parent Organization Name | SANFORD |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| N | 276400000X | Rehabilitation, Substance Use Disorder Unit | Hospital Units | ||
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Sanford Health Primewest Residential Support Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174042386 | Sanford Health of Northern Minnesota | Clinic/Center | 109 Grove Ave S Ste 1, Park Rapids, MN 56470-1787 | 2017-09-19 |
| 1902261456 | Sanford Health of Northern Minnesota | Clinic/Center | 106 5th St South, Walker, MN 56484-1123 | 2015-12-29 |
| 1700271061 | Sanford Health of Northern Minnesota | Eyewear Supplier (Equipment, not the service) | 1656 Central St W Ste A, Bagley, MN 56621-4357 | 2015-04-03 |
| 1013334457 | Sanford Health of Northern Minnesota | Optometrist | 1400 Hwy 71, International Falls, MN 56649-2189 | 2014-03-24 |
| 1770849697 | Sanford Health of Northern Minnesota | Family Medicine | 345 4th St Nw, Kelliher, MN 56650 | 2012-04-04 |
| 1457624272 | Sanford Health of Northern Minnesota | Clinic/Center | 22 Elm St Nw, Clearbrook, MN 56634 | 2012-02-10 |
| 1184728743 | Sanford Health of Northern Minnesota | Durable Medical Equipment & Medical Supplies | 1233 34th St Nw Ste B, Bemidji, MN 56601-5112 | 2006-09-12 |
| 1730292178 | Sanford Health of Northern Minnesota | Hospice Care, Community Based | 3201 Pine Ridge Ave Nw, Suite A, Bemidji, MN 56601-5101 | 2006-08-17 |
| 1659376663 | Sanford Health of Northern Minnesota | Skilled Nursing Facility | 1000 Anne St Nw, Bemidji, MN 56601-5109 | 2005-06-16 |
| 1073166674 | Sanford Health of Northern Minnesota | Pharmacy | 81 1st St Nw, Ste A, Blackduck, MN 56630-0188 | 2019-07-23 |
| Street Address |
3124 HANNAH AVE NW |
| City | BEMIDJI |
| State | MN |
| Zip Code | 56601-5625 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336772425 | Northern Minnesota Addiction Wellness Center | Substance Abuse Rehabilitation Facility | 4851 Stacy Ann Dr Nw, Bemidji, MN 56601 | 2020-02-17 |
| 1366093841 | Vickie Lynn Matthews | Technician | 1018 Miles Ave Se, Bemidji, MN 56601 | 2019-09-25 |
| 1518443530 | Lindsey Marie Whiting | Registered Nurse | 1300 Anne St, Bemidji, MN 56601 | 2018-07-12 |
| 1801257662 | Meghan Zigrida Paquette | Registered Nurse | 6055 161st Street Nw, Cass Lake, MN 56601 | 2016-03-08 |
| 1144686106 | Northwest Indian Oic | Home Health | 1819 Bemidji Ave N Ste 1, Bemidji, MN 56601 | 2016-01-06 |
| 1831560424 | Laura Hansen, Msw, Licsw Counseling Services, Inc. | Social Worker | 403 4th Street Ne, Suite 110, Bemidji, MN 56601 | 2015-10-08 |
| 1679949028 | Grand St. Paul Cvs LLC | Durable Medical Equipment & Medical Supplies | 2312 Bemidji Ave North, Bemidji, MN 56601 | 2015-08-19 |
| 1255717617 | Mary S. Salter, Md Psc | Internal Medicine | 514 Beltrami Ave Nw Suite 102, Bemidji, MN 56601 | 2015-08-07 |
| 1225420615 | Cristin Evans | Counselor | 403 4th Street, Suite 300, Bemidji, MN 56601 | 2015-02-23 |
| 1619367919 | Angela Krom Fournier | Psychologist | 16150 Golden Eagle Court Nw, Eagle Vista Equine Center Inc., Bemidji, MN 56601 | 2015-01-26 |
| Find all providers in zip 56601 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235608894 | Andrew Mark Schwab | Community Based Residential Treatment Facility, Mental Illness | 9517 Chad Dr Nw, Bemidji, MN 56601-9032 | 2018-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730796384 | Maisa Inc. | Community Based Residential Treatment Facility, Mental Illness | 1113 E Franklin Ave Ste 208c, Minneapolis, MN 55404-2977 | 2020-09-28 |
| 1043837560 | Journey of Hope Community Housing LLC | Community Based Residential Treatment Facility, Mental Illness | 761 Case Ave, Saint Paul, MN 55106-3705 | 2020-06-30 |
| 1366005696 | Armando Cavazos | Community Based Residential Treatment Facility, Mental Illness | 84 Wabasha St S Apt 330, Saint Paul, MN 55107-1856 | 2019-04-22 |
| 1205300969 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 4835-4901 West Boradway Avenue, Crystal, MN 55429 | 2019-01-16 |
| 1871064840 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 300 8th Ave Ne, Minneapolis, MN 55413-2030 | 2018-12-17 |
| 1144791112 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 5546 7th St Ne, Fridley, MN 55432-5556 | 2018-12-17 |
| 1053882027 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 7701 Able St Ne, Spring Lake Park, MN 55432-2809 | 2018-12-17 |
| 1699246678 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 1140 80th Ave Ne, Spring Lake Park, MN 55432-2039 | 2018-12-17 |
| 1962973933 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 6134 Woody Ln Ne, Fridley, MN 55432-5844 | 2018-12-17 |
| 1780155754 | Rescare Minnesota, Inc. | Community Based Residential Treatment Facility, Mental Illness | 500 Ironton St Ne, Fridley, MN 55432-1633 | 2018-12-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.