Healthcare Provider Details

I. General information

NPI: 1528450350
Provider Name (Legal Business Name): NORTHWOODS INTERFAITH VOLUNTEER CAREGIVERS PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 AMERICA AVE NW STE 110
BEMIDJI MN
56601-3853
US

IV. Provider business mailing address

616 AMERICA AVE NW STE 110
BEMIDJI MN
56601-3853
US

V. Phone/Fax

Practice location:
  • Phone: 218-333-8264
  • Fax: 218-333-8263
Mailing address:
  • Phone: 218-333-8264
  • Fax: 218-333-8263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number383337
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number1067364-1-HCBS
License Number StateMN

VIII. Authorized Official

Name: CINDI LEE JERNIGAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 218-333-8264