MEDICARE: CARDINAL OF MINNESOTA, LTD.

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
1	253Z00000X	In Home Supportive Care Agency
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326609694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDINAL OF MINNESOTA, LTD.

Provider Business Mailing Address
First Line	:	3008 WELLNER DR NE
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55906-8427
Country	:	US
Telephone Number	:	507-281-1077
Fax Number	:

Provider Business Practice Location Address
First Line	:	3008 WELLNER DR NE
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55906-8427
Country	:	US
Telephone Number	:	507-281-1077
Fax Number	:

Authorized Official
Title or Position	:	ACCOUNTANT
Name	:	HEATHER KRPATA
Credential	:
Telephone Number	:	507-281-1077

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	06/26/2019

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