Basic Information
Provider Information
NPI: 1962725358
EntityType: 2
ReplacementNPI:  
OrganizationName: MORRIS HEALTH SERVICES
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: SKYVIEW COURT
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 801 NEVADA AVE STE 100
Address2:  
City: MORRIS
State: MN
PostalCode: 562671874
CountryCode: US
TelephoneNumber: 3205892004
FaxNumber: 3205892543
Practice Location
Address1: 1000 COURT DR
Address2:  
City: MORRIS
State: MN
PostalCode: 56267
CountryCode: US
TelephoneNumber: 3205890245
FaxNumber: 3205893929
Other Information
ProviderEnumerationDate: 03/12/2010
LastUpdateDate: 04/28/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: MONCRIEF
AuthorizedOfficialFirstName: WILLIAM
AuthorizedOfficialMiddleName: JOHN
AuthorizedOfficialTitleorPosition: CFO
AuthorizedOfficialTelephone: 3205894910
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: ST. FRANCIS HEALTH SERVICES OF MORRIS, INC
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/28/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251E00000X369819MNN AgenciesHome Health 
310400000X344620MNY Nursing & Custodial Care FacilitiesAssisted Living Facility 

ID Information
IDTypeStateIssuerDescription
03070107801MNPRIMEWESTOTHER
91385520005MN MEDICAID
A77467210005MN MEDICAID


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