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Organization
RANGE MENTAL HEALTH CENTER
Active
Organization
RANGE MENTAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY J CARPENTER MSED, LP (CHIEF EXECUTIVE OFFICER)
(218) 749-2881
Entity
Organization
Contact information
Practice address
624 S 13TH ST, VIRGINIA, MN 55792
(218) 749-2881
(218) 749-3806
Mailing address
PO BOX 1188, VIRGINIA, MN 55792-1188
(218) 749-2881
(218) 749-3806
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104855400
—
MN
Enumeration date
09/26/2006
Last updated
04/01/2016
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