Healthcare Provider Details

I. General information

NPI: 1497722318
Provider Name (Legal Business Name): COUNTY OF FILLMORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 HOUSTON ST NW
PRESTON MN
55965
US

IV. Provider business mailing address

902 HOUSTON ST NW
PRESTON MN
55965-1094
US

V. Phone/Fax

Practice location:
  • Phone: 507-765-3898
  • Fax: 507-765-2139
Mailing address:
  • Phone: 507-765-3898
  • Fax: 507-765-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number328391
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: JESSICA MAE ERICKSON
Title or Position: DON
Credential: PHN
Phone: 507-765-2647