Healthcare Provider Details

I. General information

NPI: 1477552545
Provider Name (Legal Business Name): HEALTHWORKS HOME MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 COUNTY ROAD C W
ROSEVILLE MN
55113-1304
US

IV. Provider business mailing address

1895 COUNTY ROAD C W
ROSEVILLE MN
55113-1304
US

V. Phone/Fax

Practice location:
  • Phone: 612-617-9562
  • Fax:
Mailing address:
  • Phone: 612-617-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2821451
License Number StateMN

VIII. Authorized Official

Name: MAUREEN NEWVILLE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 612-617-9562