Healthcare Provider Details

I. General information

NPI: 1801899703
Provider Name (Legal Business Name): NORTH CITIES HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9899 AVOCET ST NW
COON RAPIDS MN
55433-6413
US

IV. Provider business mailing address

9899 AVOCET ST NW
COON RAPIDS MN
55433-6413
US

V. Phone/Fax

Practice location:
  • Phone: 763-757-2320
  • Fax: 763-757-6946
Mailing address:
  • Phone: 763-757-2320
  • Fax: 763-757-6946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number324795
License Number StateMN

VIII. Authorized Official

Name: MR. THOMAS DALE POLLOCK
Title or Position: ADMINISTRATOR
Credential: N.H.A.
Phone: 763-757-2320