Basic Information
| Provider Information | |||||||||
| NPI: | 1538178520 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLACIAL RIDGE HOSPITAL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 4TH AVE SE | ||||||||
| Address2: | |||||||||
| City: | GLENWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563341820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206344521 | ||||||||
| FaxNumber: | 3206342262 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 4TH AVE SE | ||||||||
| Address2: | |||||||||
| City: | GLENWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563341820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206344521 | ||||||||
| FaxNumber: | 3206342262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | STENSRUD | ||||||||
| AuthorizedOfficialFirstName: | KIRK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3206342208 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 331045 | MN | N | Hospitals | General Acute Care Hospital | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 341547300 | 05 | MN | MEDICAID | 1652HGL | 01 | MN | BLUE CROSS | OTHER | 5008075 | 01 | MEDICA | OTHER | 80142855 | 01 | RAILROAD MEDICARE | OTHER |