Provider Demographics
NPI:1205218963
Name:PRIORITY LIFE HOME CARE
Entity Type:Organization
Organization Name:PRIORITY LIFE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOPPERSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:763-257-2227
Mailing Address - Street 1:4232 STINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3358
Mailing Address - Country:US
Mailing Address - Phone:763-257-2227
Mailing Address - Fax:
Practice Address - Street 1:4232 STINSON BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-3358
Practice Address - Country:US
Practice Address - Phone:763-257-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN372672251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health