Organization
RANGE MENTAL HEALTH CENTER INC
Active
Other names
Detox
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
626 S 13TH ST, VIRGINIA, MN 55792
(218) 741-9120
(218) 741-3170
Mailing address
624 S 13TH ST, VIRGINIA, MN 55792
(218) 749-2881
(218) 749-3806
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3L52RA
BLUE CROSS BLUE SHIELD
MN
01
—
5042378
MEDICA
MN
Enumeration date
03/26/2007
Last updated
04/01/2016
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