Organization
MOOSE LAKE COMMUNITY HOSPITAL DISTRICT
Active
Other names
Mercy Hospital & Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
JASON DOUGLAS (CHIEF EXECUTIVE OFFICER)
(218) 485-5858
Entity
Organization
Contact information
Practice address
710 S KENWOOD AVE, MOOSE LAKE, MN 55767-9405
(218) 485-4481
(218) 485-5845
Mailing address
710 S KENWOOD AVE, MOOSE LAKE, MN 55767-9405
(218) 485-4481
(218) 485-5845
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
330782
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1757EME
BLUE CROSS BLUE SHIELD
MN
01
—
5024697
MEDICA CHOICE
MN
Enumeration date
11/06/2006
Last updated
08/22/2020
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