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NPI Code Detail

MEDICARE: FAIRVIEW HOME CARE AND HOSPICE

MEDICARE: FAIRVIEW HOME CARE AND HOSPICE
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1578008355
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAIRVIEW HOME CARE AND HOSPICE
Provider Business Mailing Address
First Line : 2450 RIVERSIDE AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55454-1450
Country : US
Telephone Number : 612-672-6000
Fax Number :
Provider Business Practice Location Address
First Line : 2450 26TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-1245
Country : US
Telephone Number : 952-924-7031
Fax Number :
Authorized Official
Title or Position : PRESIDENT/MNG EMP/DIRECTOR/AO
Name : PAMELA HALVORSON
Credential :
Telephone Number : 612-728-2240
Provider Enumeration Date : 01/03/2017
Last Update Date : 06/17/2020

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1093040404 — DR. NAOMI GOLOFF MD
Practice Location Address:
2450 26TH AVE S , FAIRVIEW HOME CARE AND HOSPICE
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Directions to “FAIRVIEW HOME CARE AND HOSPICE ” Practice Location

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