Healthcare Provider Details

I. General information

NPI: 1992818231
Provider Name (Legal Business Name): HOMELAND HEALTH SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 E HENNEPIN AVE STE 230
MINNEAPOLIS MN
55414-2489
US

IV. Provider business mailing address

1621 E HENNEPIN AVE STE 230
MINNEAPOLIS MN
55414-2489
US

V. Phone/Fax

Practice location:
  • Phone: 763-746-8060
  • Fax: 763-746-8063
Mailing address:
  • Phone: 763-746-8060
  • Fax: 763-746-8063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR121223-7
License Number StateMN

VIII. Authorized Official

Name: THOMAS WISTED
Title or Position: PRESIDENT & CEO
Credential:
Phone: 847-894-0774