Healthcare Provider Details

I. General information

NPI: 1942440441
Provider Name (Legal Business Name): CENTRAL MINNESOTA HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22413 STATE HIGHWAY 6 200
DEERWOOD MN
56444-6245
US

IV. Provider business mailing address

22413 STATE HIGHWAY 6 200
DEERWOOD MN
56444-6245
US

V. Phone/Fax

Practice location:
  • Phone: 218-546-5000
  • Fax: 218-546-5033
Mailing address:
  • Phone: 218-546-5000
  • Fax: 218-546-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number342906
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number342906
License Number StateMN

VIII. Authorized Official

Name: MS. VICTORIA LIVINGSTON PETERSON
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 218-546-5000