Healthcare Provider Details

I. General information

NPI: 1316956964
Provider Name (Legal Business Name): EDELWEISS HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7014 E FISH LAKE RD
MAPLE GROVE MN
55311-2832
US

IV. Provider business mailing address

7014 E FISH LAKE RD
MAPLE GROVE MN
55311-2832
US

V. Phone/Fax

Practice location:
  • Phone: 763-315-1050
  • Fax:
Mailing address:
  • Phone: 763-315-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number331449
License Number StateMN

VIII. Authorized Official

Name: MS. EDELGARD AUSTIN
Title or Position: OWNER
Credential: RN
Phone: 763-315-1050