Healthcare Provider Details

I. General information

NPI: 1205169588
Provider Name (Legal Business Name): J AND J HOLMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 TROOP DR
SARTELL MN
56377-4563
US

IV. Provider business mailing address

8365 BRANDON RD
BAXTER MN
56425-8742
US

V. Phone/Fax

Practice location:
  • Phone: 320-230-2708
  • Fax: 320-230-3145
Mailing address:
  • Phone: 218-828-0083
  • Fax: 218-828-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1022516
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number1029181
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number1014328
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number1010165
License Number StateMN

VIII. Authorized Official

Name: JANELL M KRAMER
Title or Position: CFO/OWNER
Credential:
Phone: 218-828-0083