Healthcare Provider Details

I. General information

NPI: 1689167926
Provider Name (Legal Business Name): HELPING HANDS OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PLYMOUTH ST
HOLDINGFORD MN
56340
US

IV. Provider business mailing address

PO BOX 293
HOLDINGFORD MN
56340-0293
US

V. Phone/Fax

Practice location:
  • Phone: 320-746-9960
  • Fax: 320-746-8132
Mailing address:
  • Phone: 320-746-9960
  • Fax: 320-746-8132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1071159
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1077402
License Number StateMN

VIII. Authorized Official

Name: CAROL LUNDQUIST
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 320-746-9960