Healthcare Provider Details

I. General information

NPI: 1861258816
Provider Name (Legal Business Name): HOME CARE ON BIRCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 BIRCH AVE W
HECTOR MN
55342-1064
US

IV. Provider business mailing address

420 BIRCH AVE W
HECTOR MN
55342-1064
US

V. Phone/Fax

Practice location:
  • Phone: 320-344-0091
  • Fax:
Mailing address:
  • Phone: 320-344-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GAIL E EVENSON
Title or Position: OWNER/RN
Credential: RN
Phone: 320-344-0091