Organization
MOOSE LAKE COMMUNITY HOSPITAL DISTRICT
Active
Other names
Mercy Home Health Agency
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J DELFS (CHIEF EXECUTIVE OFFICER)
(218) 485-5858
Entity
Organization
Contact information
Practice address
30 ARROWHEAD LANE, MOOSE LAKE, MN 55767
(218) 485-5506
(218) 485-5908
Mailing address
4572 COUNTY ROAD 61, MOOSE LAKE, MN 55767-9401
(218) 485-4481
(218) 485-5845
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
374783
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1757AME
BLUE CROSS BLUE SHIELD
MN
05
—
315245600
—
MN
01
—
5900060
MEDICA CHOICE
MN
Enumeration date
11/06/2006
Last updated
03/25/2016
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