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NPI Code Detail

MEDICARE: MARY T HOSPICE

MEDICARE: MARY T 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
1251G00000XCommunity Based Hospice Care Agency342612MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1342612OTHERMNHOSPICE, STATE LICENSE

General Provider Information

NPI Number : 1629214515
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARY T HOSPICE
Provider Business Mailing Address
First Line : 1555 118TH LN NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55448-7579
Country : US
Telephone Number : 763-754-2505
Fax Number : 763-755-3631
Provider Business Practice Location Address
First Line : 1555 118TH LN NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55448-7579
Country : US
Telephone Number : 763-754-2505
Fax Number : 763-862-5472
Authorized Official
Title or Position : PRESIDENT AND STOCKHOLDER
Name : MS. MARY T TJOSVOLD
Credential :
Telephone Number : 763-754-2505
Provider Enumeration Date : 12/23/2008
Last Update Date : 12/23/2008

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Directions to “MARY T HOSPICE ” Practice Location

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