IRON RANGE BEHAVIORAL SERVICES LLC (NPI# 1851900484) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1851900484 |
Entity Type | Organization |
Organization Name | IRON RANGE BEHAVIORAL SERVICES LLC |
Practice Address |
817 S 5th Ave Virginia MN 55792-2804 |
Mailing Address |
4962 Anderson Rd Hermantown MN 55811-1757 |
Practice Telephone | 2183418523 |
Mailing Telephone | 2183418523 |
Enumeration Date | 2020-07-29 |
Last Update Date | 2020-07-29 |
Authorized Official Name | MR. MARK F WICKER (PRESIDENT) |
Authorized Official Telephone | 2183418523 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities |
Street Address |
817 S 5TH AVE |
City | VIRGINIA |
State | MN |
Zip Code | 55792-2804 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1598252983 | Teresa A Larrabee | Social Worker | 624 South 13th Street, Virginia, MN 55792 | 2018-04-20 |
1972874105 | Caryn M. Walters | Counselor | 504 1st St. S., Virginia, MN 55792 | 2012-01-19 |
1144502923 | Crystal Corrine Leal | Student in an Organized Health Care Education/Training Program | 624 S. 13th St., Virginia, MN 55792 | 2011-09-16 |
1417259110 | Ellen C. Taube | Pharmacist | 306 Chestnut, Virginia, MN 55792 | 2010-12-01 |
1518295567 | Virginia-gilbert Family Dental P.a | Dentist | 612-13th. St. So., Virginia, MN 55792 | 2009-12-03 |
1942442082 | Arrowhead Economic Opportunity Agency | In Home Supportive Care | 702 South Third Avenue, Virginia, MN 55792 | 2009-04-06 |
1609037324 | Stefan Leroy Kaiser | Preventive Medicine | 1101 9th St. N, Essentia Health Virginia Clinic, Virginia, MN 55792 | 2008-06-25 |
1457512915 | Duane Faccin Person | Legal Medicine | 910 6th St N, Duluth Clinic Virginia, Virginia, MN 55792 | 2008-06-18 |
1932368313 | Range Mental Health Center Inc | Community Based Residential Treatment Facility, Mental Illness | 731 3rd St S, Virginia, MN 55792 | 2008-06-02 |
1871634071 | Gary Frederick Miller | Social Worker | 624 S 13th Street, P O 1188, Virginia, MN 55792 | 2007-02-09 |
Find all providers in zip 55792 |
Taxonomy Code | 261QM0855X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Adolescent and Children Mental Health |
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
Notes: [7/1/2003: new] |
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1164055026 | Moonlight Support Services LLC | Clinic/Center | 3110 Old Hwy 8, 206, Roseville, MN 55113-5511 | 2020-02-19 |
1285279554 | Metro Therapy Center Inc | Clinic/Center | 2520 Pillsbury Ave S Apt 306, Minneapolis, MN 55404-4208 | 2019-11-11 |
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1568017374 | The Bridge Autism Clinic LLC | Clinic/Center | 690 Cleveland Ave South, Suite 100, St Paul, MN 55116 | 2019-08-08 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.