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General NPI Number Information
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NPI Number | 1295380020
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Entity Type | Organization
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Legal Business Name | UP NORTH HHC SERVICE CORPORATION
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 17443 COUNTY ROAD 561
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City | PENGILLY
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State | MN
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Zip | 55775-2051
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Country | US
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Telephone | 763-807-9924
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Fax |
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Provider Business Mailing Address
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Address Line | 17443 COUNTY ROAD 561
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City | PENGILLY
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State | MN
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Zip | 55775-2051
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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 | RN, OWNER, MANAGER
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Name | LEIGHA MARIE HUFFMAN
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Credential | RN,BSN,PHN
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Telephone | 763-807-9924
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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 |
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License Number State |
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