Healthcare Provider Details

I. General information

NPI: 1114094620
Provider Name (Legal Business Name): HEALTHPARTNERS RC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HEALTHY WAY
OLIVIA MN
56277-1117
US

IV. Provider business mailing address

100 HEALTHY WAY
OLIVIA MN
56277-1117
US

V. Phone/Fax

Practice location:
  • Phone: 320-523-1261
  • Fax: 320-523-3458
Mailing address:
  • Phone: 320-523-1261
  • Fax: 320-523-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number331046
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number331046
License Number StateMN

VIII. Authorized Official

Name: NATHAN BLAD
Title or Position: PRESIDENT
Credential:
Phone: 320-523-3575