Provider Demographics
NPI:1316098445
Name:IRON RANGE REHABILITATION CENTER
Entity type:Organization
Organization Name:IRON RANGE REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-749-9405
Mailing Address - Street 1:901 9TH ST N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2279
Mailing Address - Country:US
Mailing Address - Phone:218-749-9405
Mailing Address - Fax:218-749-9407
Practice Address - Street 1:901 9TH ST N
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2279
Practice Address - Country:US
Practice Address - Phone:218-749-9405
Practice Address - Fax:218-749-9407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN575555700Medicaid
MN575555700Medicaid