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General NPI Number Information
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NPI Number | 1417950874
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Entity Type | Organization
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Legal Business Name | INTERIM HEALTHCARE OF LAKE SUPERIOR, INC.
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 332 W SUPERIOR ST SUITE 204
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City | DULUTH
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State | MN
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Zip | 55802
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Country | US
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Telephone | 218-722-0053
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Fax | 218-722-0318
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Provider Business Mailing Address
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Address Line | 332 W SUPERIOR ST SUITE 204
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City | DULUTH
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State | MN
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Zip | 55802
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Country | US
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Telephone | 218-722-0053
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Fax | 218-722-0318
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Authorized Official
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Title or Position | CONTROLLER
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Name | KARI JO JARVI
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Credential |
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Telephone | 218-722-0053
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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 | 327241
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License Number State | MN
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Taxonomy #2
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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 | MN
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