Healthcare Provider Details

I. General information

NPI: 1255932794
Provider Name (Legal Business Name): PROHEALTH HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 33RD AVE SW
MINOT ND
58701-7368
US

IV. Provider business mailing address

5101 14TH ST SE
MINOT ND
58701-3212
US

V. Phone/Fax

Practice location:
  • Phone: 701-721-1126
  • Fax:
Mailing address:
  • Phone: 701-721-1126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1456793
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name: JUDY ANN HOFF
Title or Position: OWNER
Credential: LPN
Phone: 701-721-1126