Provider Demographics
NPI:1699744128
Name:GRACEVILLE HEALTH CENTER
Entity type:Organization
Organization Name:GRACEVILLE HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-364-7667
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:116 W 2ND ST
Mailing Address - City:GRACEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56240-4803
Mailing Address - Country:US
Mailing Address - Phone:320-748-7261
Mailing Address - Fax:320-748-8238
Practice Address - Street 1:116 W 2ND ST
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:MN
Practice Address - Zip Code:56240-4803
Practice Address - Country:US
Practice Address - Phone:320-748-7261
Practice Address - Fax:320-748-8238
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-16
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328814314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN030525100Medicaid
MN5A75EGROtherBCBSM
MN5A75EGROtherBCBSM