1447372933 NPI number — SOUTHWESTERN MINNESOTA ADULT MENTAL HEALTH CONSORTIUM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447372933 NPI number — SOUTHWESTERN MINNESOTA ADULT MENTAL HEALTH CONSORTIUM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWESTERN MINNESOTA ADULT MENTAL HEALTH CONSORTIUM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447372933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 23RD ST NE
Provider Second Line Business Mailing Address:
SUITE 2050
Provider Business Mailing Address City Name:
WILLMAR
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56201-6600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-441-6340
Provider Business Mailing Address Fax Number:
320-441-6349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 E LYON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHALL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56258-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-537-7899
Provider Business Practice Location Address Fax Number:
507-537-7950
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCALLISTER
Authorized Official First Name:
LEE
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD CHAIR
Authorized Official Telephone Number:
507-372-2157

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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