Healthcare Provider Details

I. General information

NPI: 1548595218
Provider Name (Legal Business Name): HEALTHEAST CARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 UNIVERSITY AVE W 4TH FLOOR
SAINT PAUL MN
55104-3727
US

IV. Provider business mailing address

1655 BEAM AVE
MAPLEWOOD MN
55109-1163
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-2800
  • Fax: 651-232-2898
Mailing address:
  • Phone: 651-232-2800
  • Fax: 651-232-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number331635
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number331635
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number331635
License Number StateMN

VIII. Authorized Official

Name: DOUG DAVENPORT
Title or Position: CFO
Credential:
Phone: 651-232-2250