=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316179161
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HASTINGS FAMILY SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2009
-----------------------------------------------------
Last Update Date | 08/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 3RD ST E
-----------------------------------------------------
City | HASTINGS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55033-1211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-437-7134
-----------------------------------------------------
Fax | 651-437-1292
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 3RD ST E
-----------------------------------------------------
City | HASTINGS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55033-1211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-437-7134
-----------------------------------------------------
Fax | 651-437-1292
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | CHRIS KOOP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-437-7134
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------