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General NPI Number Information
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NPI Number | 1174723746
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Entity Type | Organization
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Legal Business Name | NORTH COUNTRY HOME CARE II, INC
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 12567 5TH AVE N # 100
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City | ZIMMERMAN
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State | MN
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Zip | 55398-8451
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Country | US
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Telephone | 763-856-9955
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Fax | 763-856-9956
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Provider Business Mailing Address
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Address Line | 12567 5TH AVE N # 100
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City | ZIMMERMAN
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State | MN
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Zip | 55398-8451
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Country | US
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Telephone | 763-856-9955
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Fax | 763-856-9956
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNA TOTTEN
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Credential |
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Telephone | 763-856-9955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 203178700
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License Number State | MN
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