=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952309403
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONNECTCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 710 PARK ISLAND DR SW
-----------------------------------------------------
City | HUTCHINSON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55350-2046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-234-5031
-----------------------------------------------------
Fax | 320-234-5032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 PARK ISLAND DR SW
-----------------------------------------------------
City | HUTCHINSON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55350-2046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-234-5031
-----------------------------------------------------
Fax | 320-234-5032
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. DEEANN DICKE
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 320-234-4611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | CLASS A
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------