Provider Demographics
NPI:1376286989
Name:HEARTHSTONE CARE GROUP LLC
Entity Type:Organization
Organization Name:HEARTHSTONE CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-560-9636
Mailing Address - Street 1:PO BOX 853
Mailing Address - Street 2:
Mailing Address - City:MOOSE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55767-0853
Mailing Address - Country:US
Mailing Address - Phone:218-565-7565
Mailing Address - Fax:218-228-5450
Practice Address - Street 1:441 ARROWHEAD LN UNIT B
Practice Address - Street 2:
Practice Address - City:MOOSE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55767-7702
Practice Address - Country:US
Practice Address - Phone:614-560-9636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based