MEDICARE: NORTHSTAR CARE CONNECTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	163WC0400X	Case Management Registered Nurse
2	251S00000X	Community/Behavioral Health Agency
3	253Z00000X	In Home Supportive Care Agency
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	261QM0855X	Adolescent and Children Mental Health Clinic/Center
6	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1144947821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSTAR CARE CONNECTIONS

Provider Business Mailing Address
First Line	:	15117 EMORY CIR
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55124-1808
Country	:	US
Telephone Number	:	612-232-8222
Fax Number	:

Provider Business Practice Location Address
First Line	:	15117 EMORY CIR
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55124-1808
Country	:	US
Telephone Number	:	612-232-8222
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ADNO GATAH
Credential	:	DNP
Telephone Number	:	612-232-8224

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/31/2022

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