Healthcare Provider Details

I. General information

NPI: 1942203864
Provider Name (Legal Business Name): PENNINGTON & RED LAKE COUNTY PUBLIC HEALTH & HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MAIN AVE N
THIEF RIVER FALLS MN
56701-1901
US

IV. Provider business mailing address

101 MAIN AVE N
THIEF RIVER FALLS MN
56701-1901
US

V. Phone/Fax

Practice location:
  • Phone: 218-681-0876
  • Fax: 218-683-7099
Mailing address:
  • Phone: 218-681-0876
  • Fax: 218-683-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number326512
License Number StateMN

VIII. Authorized Official

Name: KAYLA R JORE
Title or Position: DIRECTOR
Credential: PHN
Phone: 218-681-0876