Organization
PELICAN VALLEY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD KENNETH BRATLIEN (BOARD CHAIRPERSON)
(218) 842-5106
Entity
Organization
Contact information
Practice address
211 E MILL STREET, PELICAN RAPIDS, MN 56572-0645
(218) 863-2991
(218) 863-5255
Mailing address
PO BOX 645, PELICAN RAPIDS, MN 56572-0645
(218) 863-2911
(218) 863-5255
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
331787
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30326
—
ND
05
—
537342500
—
MN
01
—
7150033
MEDICA
MN
01
—
8979PE
BCBS
MN
01
—
NH0312
UCARE
MN
Enumeration date
07/25/2006
Last updated
08/22/2020
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