Healthcare Provider Details

I. General information

NPI: 1285737460
Provider Name (Legal Business Name): INTERIM HEALTHCARE OF THE TWIN CITIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 UNIVERSITY AVE W SUITE 160
SAINT PAUL MN
55114-1839
US

IV. Provider business mailing address

2200 UNIVERSITY AVE W SUITE 160
SAINT PAUL MN
55114-1839
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 TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number332058
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number331122
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number331118
License Number StateMN

VIII. Authorized Official

Name: MR. THOMAS RICHARD GEARY
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 651-917-3634