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General NPI Number Information
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NPI Number | 1891066239
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Entity Type | Organization
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Legal Business Name | MINNESOTA HOSPICE LLC
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Dates
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Enumeration Date | 01/17/2012
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Last Update Date | 08/23/2017
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Provider Practice Location Address
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Address Line | 17645 JUNIPER PATH SUITE 155
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City | LAKEVILLE
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State | MN
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Zip | 55044-7490
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Country | US
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Telephone | 952-898-1022
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Fax | 952-898-4006
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Provider Business Mailing Address
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Address Line | 17645 JUNIPER PATH SUITE 155
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City | LAKEVILLE
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State | MN
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Zip | 55044-7577
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Country | US
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Telephone | 952-898-1022
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Fax | 952-898-4006
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH HAGLIND
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Credential |
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Telephone | 952-898-1022
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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 | 355830
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 379554
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License Number State | MN
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