Healthcare Provider Details

I. General information

NPI: 1053084475
Provider Name (Legal Business Name): HOMEBASE HOUSING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 LAUREL ST STE 2
BRAINERD MN
56401-3586
US

IV. Provider business mailing address

102 LAUREL ST STE 2
BRAINERD MN
56401-3586
US

V. Phone/Fax

Practice location:
  • Phone: 218-831-8710
  • Fax:
Mailing address:
  • Phone: 218-831-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RYAN MENZEL
Title or Position: CEO
Credential:
Phone: 218-831-8710