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General NPI Number Information
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NPI Number | 1346487238
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Entity Type | Organization
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Legal Business Name | MARY T HOME HEALTH INC
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 06/24/2022
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Provider Practice Location Address
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Address Line | 299 COON RAPIDS BLVD NW STE 204
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City | COON RAPIDS
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State | MN
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Zip | 55433-5870
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Country | US
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Telephone | 763-772-9963
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Fax | 763-772-9962
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Provider Business Mailing Address
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Address Line | 299 COON RAPIDS BLVD NW STE 204
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City | COON RAPIDS
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State | MN
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Zip | 55433-5870
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Country | US
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Telephone | 763-772-9963
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Fax | 763-772-9962
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Authorized Official
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Title or Position | CAO
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Name | JASON TJOSVOLD
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Credential |
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Telephone | 763-567-8951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 379633
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License Number State | MN
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