Northern Tranquility Mental Health Services
Organization Active NPI Community/Behavioral Health Agency · Chisholm, MN
NPI 1700469640 · NPPES record last updated Aug 6, 2024
Key facts
- NPI
- 1700469640
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- NORTHERN TRANQUILITY MENTAL HEALTH SERVICES
- Practice address
- 12 W Lake St
Chisholm, MN 55719-1817 - Phone
- (218) 296-0688
- Fax
- (844) 921-1071
- NPI assigned
- Apr 29, 2021
- Organization subpart
- No
Authorized official
- Name
- Melissa Sue Brusacoram, APRN-CNP
- Title
- Owner, Ceo, Aprn-CNP, Pmhnp-BC
- Phone
- (218) 254-0101
Practitioners 8
-
Melissa Sue Brusacoram, APRN, CNP
-
Roxanne Jo Dobrava, MSN, APRN, PMHNP-BC
-
Mallory Jene Grani, APRN, CNP, PMHNP-C
-
Jonathan E Rohde, NP
-
Karena Beth Rother, DNP, CNP, PMHNP-BC
-
Chandra Lynn White, PMHNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210820003039 | MN | Part B Supplier - Clinic/Group Practice | 4981009479 |
Receives reassigned benefits from 8 practitioners Practice locations: Chisholm, MN |
National Provider Directory
Locations
118 W Lake St
Chisholm, MN 55719
Phone (218) 254-0101
12 W Lake St
Chisholm, MN 55719
Phone (218) 254-0101
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
12 W Lake St
Chisholm, MN 55719-1817
Mailing address
12 W Lake St
Chisholm, MN 55719-1817
Phone (218) 254-0101
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Kareo | Direct |
Other providers in Chisholm, MN
- Longyear Inc of Chisholm
- Janice Ann Mehle
- Michael Joseph Mitchell
- Angela Nelson
- NHS Northstar, Inc.
- Erin Margaret Patch
- Range Center, Inc
- Jonathan E Rohde
- Serving Hands Inc
- Serving Hart, Inc
All providers in Chisholm, MN · Community/Behavioral Health Agency in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.