Healthcare Provider Details

I. General information

NPI: 1417098286
Provider Name (Legal Business Name): NORTH HOMES, INC. - CADI-WAIVER SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 RIVER RD
GRAND RAPIDS MN
55744-4085
US

IV. Provider business mailing address

1880 RIVER RD
GRAND RAPIDS MN
55744-4085
US

V. Phone/Fax

Practice location:
  • Phone: 218-327-3000
  • Fax: 218-327-1871
Mailing address:
  • Phone: 218-327-3000
  • Fax: 218-327-1871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. TIM ADAMICH
Title or Position: DIRECTOR OF FINANCE & MARKETING
Credential:
Phone: 218-327-3000