Healthcare Provider Details

I. General information

NPI: 1124303599
Provider Name (Legal Business Name): INTERIM HEALTHCARE OF THE TWIN CITIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 FAIRVIEW AVE N
ROSEVILLE MN
55113-1325
US

IV. Provider business mailing address

2833 FAIRVIEW AVE N
ROSEVILLE MN
55113-1325
US

V. Phone/Fax

Practice location:
  • Phone: 651-917-3634
  • Fax: 651-917-3620
Mailing address:
  • Phone: 651-917-3634
  • Fax: 651-917-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TOM GEARY
Title or Position: COO
Credential:
Phone: 651-294-7985