Provider Demographics
NPI:1972698561
Name:GPH BEMIDJI, INC
Entity type:Organization
Organization Name:GPH BEMIDJI, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:218-444-4346
Mailing Address - Street 1:1700 30TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-5608
Mailing Address - Country:US
Mailing Address - Phone:218-444-4346
Mailing Address - Fax:218-444-4083
Practice Address - Street 1:1700 30TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5608
Practice Address - Country:US
Practice Address - Phone:218-444-4346
Practice Address - Fax:218-444-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility