Provider Demographics
NPI:1447401732
Name:MAXICARE MINNESOTA, INC
Entity Type:Organization
Organization Name:MAXICARE MINNESOTA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-695-8953
Mailing Address - Street 1:10700 HIGHWAY 55
Mailing Address - Street 2:STE PH
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6100
Mailing Address - Country:US
Mailing Address - Phone:612-695-8953
Mailing Address - Fax:763-390-5722
Practice Address - Street 1:10700 HIGHWAY 55
Practice Address - Street 2:STE PH
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6100
Practice Address - Country:US
Practice Address - Phone:612-695-8953
Practice Address - Fax:763-390-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-04
Last Update Date:2008-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health