MEDICARE: GINGER CARE HOME, INC.

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	320700000X	Physical Disabilities Residential Treatment Facility	1026041-1-AFC	MN

General Provider Information

NPI Number	:	1982816062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GINGER CARE HOME, INC.

Provider Business Mailing Address
First Line	:	42676 GINGER AVE
Second Line	:
City	:	HARRIS
State	:	MN
Zip	:	55032-3380
Country	:	US
Telephone Number	:	651-674-4884
Fax Number	:	651-674-4884

Provider Business Practice Location Address
First Line	:	42756 GINGER AVE
Second Line	:
City	:	HARRIS
State	:	MN
Zip	:	55032-3682
Country	:	US
Telephone Number	:	651-674-0187
Fax Number	:	651-237-0983

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN THEODORE PERRON
Credential	:
Telephone Number	:	651-674-4884

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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