Healthcare Provider Details

I. General information

NPI: 1316942824
Provider Name (Legal Business Name): BEECHWOOD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 CHICAGO AVENUE SOUTH
MINNEAPOLIS MN
55407-2614
US

IV. Provider business mailing address

3901 CHICAGO AVENUE SOUTH
MINNEAPOLIS MN
55407-2614
US

V. Phone/Fax

Practice location:
  • Phone: 612-824-0415
  • Fax: 612-825-0789
Mailing address:
  • Phone: 612-824-0415
  • Fax: 612-825-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number325089
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMN

VIII. Authorized Official

Name: FANNY D GAURNIZO MILLER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 612-824-0415