Provider Demographics
NPI:1063952026
Name:GLACIAL RIDGE HOSPITAL DISTRICT
Entity type:Organization
Organization Name:GLACIAL RIDGE HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:A
Authorized Official - Last Name:STENSRUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-634-2208
Mailing Address - Street 1:10 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1820
Mailing Address - Country:US
Mailing Address - Phone:320-634-4521
Mailing Address - Fax:320-634-2244
Practice Address - Street 1:496 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STARBUCK
Practice Address - State:MN
Practice Address - Zip Code:56381-4616
Practice Address - Country:US
Practice Address - Phone:320-634-4521
Practice Address - Fax:320-634-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health