Provider Demographics
NPI:1881767069
Name:SPECTRUM COMMUNITY HEALTH, INC.
Entity type:Organization
Organization Name:SPECTRUM COMMUNITY HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT OF OPERATIONS, RN
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-451-0569
Mailing Address - Street 1:2000 SIEGEL BLVD
Mailing Address - Street 2:
Mailing Address - City:EVELETH
Mailing Address - State:MN
Mailing Address - Zip Code:55734-8642
Mailing Address - Country:US
Mailing Address - Phone:218-741-3013
Mailing Address - Fax:
Practice Address - Street 1:2000 SIEGEL BLVD
Practice Address - Street 2:
Practice Address - City:EVELETH
Practice Address - State:MN
Practice Address - Zip Code:55734-8642
Practice Address - Country:US
Practice Address - Phone:218-741-3013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN313695310400000X
MN334658251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN751355100Medicaid
MN109875OtherUCARE
MN109875OtherUCARE OR SOUTH COUNTRY
MN151101OtherPRIME WEST
MN120015OtherFIRST PLAN
MN5900097OtherMEDICA - GRAND RAPIDS
MN5900098OtherMEDICA - WILLMAR
MN5900101OtherMEDICA - EVELETH
MN1023413OtherPREFERRED ONE
MN5900095OtherMEDICA - DULUTH
MN8X73SPOtherBCBS
MN5900099OtherMEDICA - ROCHESTER
MN5900100OtherMEDICA - MINNEAPOLIS
MN5900096OtherMEDICA - FAIRIBAULT
MN=========200OtherHUMANA
MN=========55076OtherTRICARE WEST
MN120015OtherFIRST PLAN
MN5900101OtherMEDICA - EVELETH
MN=========AOtherITASCA MEDICAL CARE
MN247127Medicare Oscar/Certification