MEDICARE: MAHUBE-OTWA COMMUNITY ACTION PARTNERSHIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	A246932400	MN

General Provider Information

NPI Number	:	1285910596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHUBE-OTWA COMMUNITY ACTION PARTNERSHIP

Provider Business Mailing Address
First Line	:	PO BOX 747
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56502-0747
Country	:	US
Telephone Number	:	218-847-1385
Fax Number	:	218-847-1388

Provider Business Practice Location Address
First Line	:	1125 W RIVER RD
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-2722
Country	:	US
Telephone Number	:	218-847-1385
Fax Number	:	218-847-1388

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ELIZABETH KUOPPALA
Credential	:
Telephone Number	:	218-847-1385

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	05/07/2019

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