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NPI Code Detail

MEDICARE: BEECHWOOD, INC.

MEDICARE: BEECHWOOD, INC.
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health AgencyMN
2251E00000XHome Health Agency325089MN
3251E00000XHome Health AgencyMN

General Provider Information

NPI Number : 1316942824
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEECHWOOD, INC.
Provider Business Mailing Address
First Line : 3901 CHICAGO AVENUE SOUTH
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-2614
Country : US
Telephone Number : 612-824-0415
Fax Number : 612-825-0789
Provider Business Practice Location Address
First Line : 3901 CHICAGO AVENUE SOUTH
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-2614
Country : US
Telephone Number : 612-824-0415
Fax Number : 612-825-0789
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : FANNY D GAURNIZO MILLER
Credential :
Telephone Number : 612-824-0415
Provider Enumeration Date : 06/21/2005
Last Update Date : 03/17/2017

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