Healthcare Provider Details

I. General information

NPI: 1609048883
Provider Name (Legal Business Name): PRESBYTERIAN HOMES HOSPICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 HAMLINE AVE N
ROSEVILLE MN
55113-7127
US

IV. Provider business mailing address

2845 HAMLINE AVE N
ROSEVILLE MN
55113-7127
US

V. Phone/Fax

Practice location:
  • Phone: 651-746-8200
  • Fax:
Mailing address:
  • Phone: 651-746-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number338275
License Number StateMN

VIII. Authorized Official

Name: MARK THOMAS MEYER
Title or Position: CFO
Credential:
Phone: 651-631-6120