NPIMap

Organization Active NPI

Kittson Memorial Hospital Association

Doing business as Kittson Memorial Healthcare Center

  • Medicare Defined Swing Bed Hospital Unit
  • Hallock, MN
National Provider Identifier
1104022441
Registry record updated Jul 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
334536 Issued in MN
Legal business name
KITTSON MEMORIAL HOSPITAL ASSOCIATION
Doing business as
Kittson Memorial Healthcare Center
Practice address
1010 S Birch Ave
Post Office Box 700
Hallock, MN 56728-4215
Phone
(218) 843-3612
NPI assigned
Jun 25, 2007
Last updated
Jul 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2025

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

Authorized official

Name
Andrea Swenson
Title
Ceo
Phone
(218) 843-3612

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 334536 MN Primary

Addresses

Primary practice location

1010 S Birch Ave
Post Office Box 700
Hallock, MN 56728-4215

Mailing address

1010 S Birch Ave
Post Office Box 700
Hallock, MN 56728-4215
Phone (218) 843-3612

Other names 1

  • Kittson Memorial Healthcare Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120123000379 MN Part A Provider - Critical Access Hospital 1355251315 Practice locations: Hallock, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104022441. Details of each certification follow.

Hospital certification: CCN 24Z336

Legal name
KITTSON MEMORIAL HOSPITAL ASSOCIATION
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1922 in MN
Enrollment address
1010 S Birch Ave
Hallock, MN 56728-4215
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Kittson Memorial Hospit7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jana Dolores Riley Individual Corporate DirectorBoard Member Jan 1, 2019
Sandy Wilson Individual Corporate DirectorBoard Member Aug 8, 2018
Hugh Hunt Individual Corporate DirectorBoard Member Feb 13, 2017
Curtis Allan Bach Individual Corporate OfficerCfo Mar 13, 2023
Carlene L Cole Individual W-2 Managing Employee Apr 23, 1990
Operational/Managerial ControlHim/HR Manager Apr 23, 1990
Stacy Diamond Individual Corporate DirectorBoard Member Feb 26, 2023
Roland Larter Individual Corporate DirectorBoard Member Jan 1, 2017
Robert Jaszczak Individual Corporate DirectorBoard Member Jan 1, 2018
Andrea Swenson Individual Corporate OfficerCeo Apr 1, 2023
Kenny Hultgren Individual Corporate DirectorBoard Member Feb 26, 2023
Janelle Craigmile Individual Corporate DirectorBoard Member Jan 1, 2003

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751500800000",
    "number": "1104022441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 S BIRCH AVE",
            "address_2": "POST OFFICE BOX 700",
            "city": "HALLOCK",
            "state": "MN",
            "postal_code": "567284215",
            "telephone_number": "218-843-3612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 S BIRCH AVE",
            "address_2": "POST OFFICE BOX 700",
            "city": "HALLOCK",
            "state": "MN",
            "postal_code": "567284215",
            "telephone_number": "218-843-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KITTSON MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2025-07-03",
        "certification_date": "2025-07-03",
        "status": "A",
        "authorized_official_last_name": "SWENSON",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "218-843-3612"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MN",
            "license": "334536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kittson Memorial Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kittson Memorial Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hallock, MN

Sources for this page

Verify at the official NPI Registry.