Eveleth Mental Health Services Socs

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

License

330994 Issued in MN

Legal business name

EVELETH MENTAL HEALTH SERVICES SOCS

Practice address

227 McKinley Ave
Eveleth, MN 55734-1606

Phone

(218) 485-5000

NPI assigned

Jun 1, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Rod L Kornrumpf

Title

Mental Health Admin Officer

Phone

(763) 712-4010

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013954460. Details of each certification follow.

• CCN 244006 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 244006

Legal name

EVELETH BEHAVIORAL HEALTH SOS

Certification status

Terminated Voluntary: merger or closure, Dec 5, 2007

Provider type (POS)

Hospital – Psychiatric

Participating since

Jul 1, 1966

Last certification

Sep 27, 2006

Beds

16

Ownership / control type

State

Facility address

227 McKinley Avenue
Eveleth, MN 55734

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013954460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64979",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551640979",
            "telephone_number": "651-431-3676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 MCKINLEY AVE",
            "city": "EVELETH",
            "state": "MN",
            "postal_code": "557341606",
            "telephone_number": "218-485-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVELETH MENTAL HEALTH SERVICES SOCS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KORNRUMPF",
        "authorized_official_first_name": "ROD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MENTAL HEALTH ADMIN OFFICER",
        "authorized_official_telephone_number": "763-712-4010",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "MN",
            "license": "330994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Matthew Arnold Gahn, O.D.
• John Tyler Garner, D.P.M.
• Independent School District #2154
• Jons Drug Inc (Jons Drug)
• Lewis L Lester IV, MPA

• Psychiatric Hospital in Eveleth, MN
• Providers in Eveleth, MN by specialty
• Psychiatric Hospital in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.