Healthcare Provider Details

I. General information

NPI: 1205893088
Provider Name (Legal Business Name): NORTHOME HEALTHCARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11995 MAIN ST
NORTHOME MN
56661-8077
US

IV. Provider business mailing address

11995 MAIN ST PO BOX 138
NORTHOME MN
56661-8077
US

V. Phone/Fax

Practice location:
  • Phone: 218-897-5235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number330574
License Number StateMN

VIII. Authorized Official

Name: HOWIE GROFF
Title or Position: PRESIDENT
Credential:
Phone: 952-888-2923