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General NPI Number Information
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NPI Number | 1699838029
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Entity Type | Organization
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Legal Business Name | GREEN PINE ACRES
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 427 MAIN ST NE
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City | MENAHGA
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State | MN
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Zip | 56464-8702
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Country | US
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Telephone | 218-564-4101
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Fax | 218-564-5309
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Provider Business Mailing Address
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Address Line | 427 MAIN ST NE
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City | MENAHGA
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State | MN
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Zip | 56464-8702
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Country | US
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Telephone | 218-564-4101
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Fax | 218-564-5309
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. CLAIR E ERICKSON
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Credential |
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Telephone | 218-564-4101
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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 | 331360
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License Number State | MN
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