NPIMap

Organization Active NPI

Sanford Health Network North

Doing business as Sanford Behavioral Health Center

  • Psychiatric Hospital
  • Thief River Falls, MN
National Provider Identifier
1790842466
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
SANFORD HEALTH NETWORK NORTH
Doing business as
Sanford Behavioral Health Center
Sanford Health Northern Lights Residence
Practice address
921 Atlantic Ave
Thief River Falls, MN 56701-1638
Phone
(218) 681-8706
Fax
(218) 681-2816
NPI assigned
Jan 2, 2007
Last updated
Mar 23, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SANFORD HEALTH NETWORK NORTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

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

Authorized official

Name
Tony Lee Morrison
Title
Vice President, Revenue Cycle
Phone
(605) 328-8380

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X MN
Developmentally Disabled Services Day Training Agency 251C00000X MN
Adult Mental Health Clinic/Center 261QM0850X FBL-18326-12117 MN
Adolescent and Children Mental Health Clinic/Center 261QM0855X MN
Psychiatric Hospital Unit 273R00000X MN
Substance Use Disorder Rehabilitation Hospital Unit 276400000X 107543-1-CDT MN
Psychiatric Hospital 283Q00000X Primary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 350301 MN

Addresses

Primary practice location

921 Atlantic Ave
Thief River Falls, MN 56701-1638

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (053) 286-5856

Other practice location 1

101 Knight Ave S
Thief River Falls, MN 56701-2813
Phone (218) 683-4338

Other practice location 2

300 Spruce Ave S
Thief River Falls, MN 56701-3335
Phone (218) 683-4338

Other practice location 3

120 LaBree Ave S
Thief River Falls, MN 56701-2819
Phone (218) 683-4349

Other practice location 4

601 County Road 61
Thief River Falls, MN 56701-4004
Phone (218) 683-4338

Other practice location 5

715 Delmore Dr
Roseau, MN 56751-1534
Phone (218) 683-4338

Other names 2

  • Sanford Behavioral Health Center Doing business as
  • Sanford Health Northern Lights Residence Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20180205002429 MN Part B Supplier - Clinic/Group Practice 8022206663 Receives reassigned benefits from 232 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wheaton, MN; Ulen, MN; Thief River Falls, MN; Halstad, MN; Roseau, MN; Plymouth, MN; Pequot Lakes, MN; Moorhead, MN…
O20180222001872 MN Part A Provider - Critical Access Hospital 8022206663 Receives reassigned benefits from 132 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Thief River Falls, MN
O20180223000421 MN Part A Provider - Hospital 8022206663 Practice locations: Thief River Falls, MN

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1790842466. Details of each certification follow.

Hospital certification: CCN 241381

Legal name
SANFORD HEALTH NETWORK NORTH
Doing business as
SANFORD THIEF RIVER FALLS
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 31, 2005
Last certification
Apr 10, 2024
Beds
36 (25 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 2018 in ND
Enrollment address
3001 Sanford Pkwy
Thief River Falls, MN 56701-2700

Hospital certification: CCN 244018

Legal name
SANFORD HEALTH NETWORK NORTH
Doing business as
SANFORD BEHAVIORAL HEALTH CENTER
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Apr 26, 2016
Last certification
Dec 13, 2018
Beds
16
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 2018 in ND
Enrollment address
120 Labree Ave S
Thief River Falls, MN 56701-2819
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

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

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Sanford Thief River Falls Medical CenterCCN 241381 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Care Compare: Hospital

Medicare Care Compare
Listed as
Sanford Behavioral Health CenterCCN 244018 · All quality measures
Type
Psychiatric
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Sanford Health Network North14 organizations share this tax ID, including this one
Part of
Sanford Health Network North

Other organizations with this tax ID 13

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

View all 13

Locations

300 Spruce Ave S
Thief River Falls, MN 56701
Phone (218) 683-4338

921 Atlantic Ave
Thief River Falls, MN 56701
Phone (218) 681-8706

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Mark Allen Lundeen Individual Corporate DirectorTrustee Nov 19, 2014
Corporate DirectorTrustee Dec 2, 2014
Marnie Lynn Ventling-Herrmann Individual Corporate OfficerTrustee/Vice Chairperson Jan 1, 2024
Corporate DirectorTrustee/Vice Chairperson Jan 1, 2022
Tony Lee Morrison Individual W-2 Managing EmployeeVP, Revenue Cycle Jan 19, 2020
W-2 Managing EmployeeVP, Chief Revenue Cycle Officer Jan 19, 2020
Brent Gerard Teiken Individual Corporate DirectorBoard Member Sep 1, 2010
Corporate DirectorTrustee Jul 3, 2012
Susan Drake Jarvis Individual Corporate OfficerPresident Jan 1, 2023
W-2 Managing EmployeePresident Jan 1, 2023
Kristin Kaye Herrmann Individual W-2 Managing EmployeeChief Financial Officer, Fargo Apr 24, 2022
Jolyn Joy Munson Individual W-2 Managing EmployeeVP, Revenue Cycle Operations Apr 17, 2025
Dana James Dykhouse Individual Corporate DirectorTrustee Jan 1, 2024
Andrew Stewart North Individual Corporate OfficerTrustee/Secretary Jan 1, 2020
Corporate DirectorTrustee/Secretary Jan 1, 2017
Corporate OfficerTrustee, Secretary Jan 1, 2020
Corporate DirectorTrustee, Secretary Jan 1, 2017
Stephanie Marie Herseth Sandlin Individual Corporate DirectorTrustee Jan 1, 2024
William Joseph Gassen Individual Corporate OfficerTrustee/ Ceo Nov 24, 2020
Corporate DirectorTrustee/ Ceo Nov 24, 2020
Douglas Marlin Griffin Individual W-2 Managing EmployeeChief Physician, Fargo Sep 25, 2022
George Joseph Brown Individual Corporate OfficerTrustee/ Treasurer Jan 1, 2025
Corporate DirectorTrustee/ Treasurer Jan 1, 2025
Wesley Owen Engbrecht Individual Corporate DirectorTrustee Jan 1, 2021
Maureen Patricia McCausland Individual Corporate DirectorTrustee Jan 1, 2025
Sanford Organization, Fargo, ND 5% Or Greater Indirect Ownership Interest Mar 1, 2011 100%
Thomas Richard Wenzel Individual Corporate DirectorTrustee Jan 1, 2025
David Jonathan Shulkin Individual Corporate DirectorTrustee Jan 1, 2024
Neil Leslie Gulsvig Individual Corporate DirectorTrustee Mar 28, 2019
Kevin Victor Schieffer Individual Corporate DirectorTrustee Jan 1, 2025
Lauris Nelson Molbert Individual Corporate DirectorTrustee/Chairperson Jan 1, 2021
Corporate OfficerTrustee/Chairperson Jan 1, 2024
Corporate DirectorTrustee/ Chairperson Jan 1, 2021
Nicholas Wayne Olson Individual W-2 Managing Employee Apr 8, 2024
W-2 Managing EmployeeCfo Apr 8, 2024
Sanford North Organization, Bismarck, ND Corporation, Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2011 100%
5% Or Greater Direct Ownership Interest Oct 31, 2007 100%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 31

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 31

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

Affiliated clinicians 168

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

View all 168

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616457600000",
    "number": "1790842466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "053-286-5856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 ATLANTIC AVE",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567011638",
            "telephone_number": "218-681-8706",
            "fax_number": "218-681-2816"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Knight Ave S",
            "address_purpose": "LOCATION",
            "city": "Thief River Falls",
            "state": "MN",
            "postal_code": "567012813",
            "country_code": "US",
            "telephone_number": "218-683-4338",
            "fax_number": "218-683-4551",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Spruce Ave S",
            "address_purpose": "LOCATION",
            "city": "Thief River Falls",
            "state": "MN",
            "postal_code": "567013335",
            "country_code": "US",
            "telephone_number": "218-683-4338",
            "fax_number": "218-683-4551",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 LaBree Ave S",
            "address_purpose": "LOCATION",
            "city": "Thief River Falls",
            "state": "MN",
            "postal_code": "567012819",
            "country_code": "US",
            "telephone_number": "218-683-4349",
            "fax_number": "218-683-2595",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 County Road 61",
            "address_purpose": "LOCATION",
            "city": "Thief River Falls",
            "state": "MN",
            "postal_code": "567014004",
            "country_code": "US",
            "telephone_number": "218-683-4338",
            "fax_number": "218-683-4551",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "715 Delmore Dr",
            "address_purpose": "LOCATION",
            "city": "Roseau",
            "state": "MN",
            "postal_code": "567511534",
            "country_code": "US",
            "telephone_number": "218-683-4338",
            "fax_number": "218-683-4551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SANFORD HEALTH NETWORK NORTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANFORD HEALTH NETWORK NORTH",
        "enumeration_date": "2007-01-02",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A",
        "authorized_official_last_name": "MORRISON",
        "authorized_official_first_name": "TONY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "VICE PRESIDENT, REVENUE CYCLE",
        "authorized_official_telephone_number": "605-328-8380"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MN",
            "license": "FBL-18326-12117",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": "MN",
            "license": "107543-1-CDT",
            "primary": false
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MN",
            "license": "350301",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Sanford Behavioral Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Health Northern Lights Residence",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Health Northern Lights Residence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thief River Falls, MN

Sources for this page

Verify at the official NPI Registry.