MEDICARE: PROVIDE CARE, 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
1	104100000X	Social Worker	045822800	MN

General Provider Information

NPI Number	:	1669549887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDE CARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 538
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-0538
Country	:	US
Telephone Number	:	651-674-8312
Fax Number	:	651-674-8299

Provider Business Practice Location Address
First Line	:	4722 ISANTI TRL
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-5420
Country	:	US
Telephone Number	:	651-674-8312
Fax Number	:	651-674-8299

Authorized Official
Title or Position	:	COMPTROLLER
Name	:	SUSAN KAY ROD
Credential	:
Telephone Number	:	651-674-8312

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	04/11/2018

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