=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336196633
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH HOMES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2006
-----------------------------------------------------
Last Update Date | 07/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1880 RIVER RD
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55744-4085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-327-3000
-----------------------------------------------------
Fax | 218-327-1871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 SE 1ST ST
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55744-3681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-327-3000
-----------------------------------------------------
Fax | 218-327-1871
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING SPECIALIST
-----------------------------------------------------
Name | TRACY LEE FILIPI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 218-751-0282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 322D00000X
-----------------------------------------------------
Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
-----------------------------------------------------
License Number | 1010657-3-CRF
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------