Healthcare Provider Details

I. General information

NPI: 1275751950
Provider Name (Legal Business Name): CCM HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/14/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 MN-7
MONTEVIDEO MN
56265-1715
US

IV. Provider business mailing address

824 N 11TH ST
MONTEVIDEO MN
56265-1629
US

V. Phone/Fax

Practice location:
  • Phone: 320-321-8485
  • Fax: 320-321-8493
Mailing address:
  • Phone: 320-269-8877
  • Fax: 320-269-8186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number333763
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRIAN LOVDAHL
Title or Position: CEO
Credential:
Phone: 320-269-8877