Provider Demographics
NPI:1194804609
Name:RURAL MINNESOTA BEHAVIORAL HEALTH SERVICES, INC
Entity type:Organization
Organization Name:RURAL MINNESOTA BEHAVIORAL HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TARUTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-209-5952
Mailing Address - Street 1:800 BEMIDJI AVE N
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3054
Mailing Address - Country:US
Mailing Address - Phone:218-333-0323
Mailing Address - Fax:218-333-0335
Practice Address - Street 1:800 BEMIDJI AVE N
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3054
Practice Address - Country:US
Practice Address - Phone:218-333-0323
Practice Address - Fax:218-333-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR116114-2363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN440066600Medicaid
MNDC9524OtherRAILROAD MEDICARE
MN233G5RUOtherBCBS
MNDC9524OtherRAILROAD MEDICARE