Healthcare Provider Details

I. General information

NPI: 1053981266
Provider Name (Legal Business Name): ACCENTCARE FAIRVIEW HEALTH MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 98TH ST STE 20
BLOOMINGTON MN
55420-4700
US

IV. Provider business mailing address

225 W MULBERRY ST STE 102 ATTN MECCA
DENTON TX
76201
US

V. Phone/Fax

Practice location:
  • Phone: 952-885-6185
  • Fax: 952-885-6045
Mailing address:
  • Phone: 940-220-2074
  • Fax: 844-595-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State

VIII. Authorized Official

Name: DENA SCHWARTZ-DOTY
Title or Position: AO
Credential:
Phone: 972-201-3819