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General NPI Number Information
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NPI Number | 1205893088
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Entity Type | Organization
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Legal Business Name | NORTHOME HEALTHCARE CENTER, INC
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 11995 MAIN ST
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City | NORTHOME
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State | MN
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Zip | 56661-8077
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Country | US
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Telephone | 218-897-5235
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Fax |
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Provider Business Mailing Address
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Address Line | 11995 MAIN ST PO BOX 138
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City | NORTHOME
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State | MN
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Zip | 56661-8077
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOWIE GROFF
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Credential |
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Telephone | 952-888-2923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 330574
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License Number State | MN
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