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
1	251G00000X	Community Based Hospice Care Agency	329541	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	241514	OTHER	MN	MEDICARE PROVIDER NUMBER

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
3	6012484	OTHER	MN	MEDICA

General Provider Information

NPI Number	:	1710966353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRVIEW HOME CARE AND HOSPICE

Provider Business Mailing Address
First Line	:	2450 26TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-9854
Country	:	US
Telephone Number	:	612-728-2350
Fax Number	:	612-728-2400

Provider Business Practice Location Address
First Line	:	2450 26TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-9854
Country	:	US
Telephone Number	:	612-728-2350
Fax Number	:	612-728-2400

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAMELA HALVORSON
Credential	:
Telephone Number	:	612-728-2340

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	09/26/2018

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Directions to “FAIRVIEW HOME CARE AND HOSPICE ” Practice Location

Language	Start Address	Practice Location

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