Provider Demographics
NPI:1477540862
Name:UNITY FAMILY HEALTHCARE
Entity Type:Organization
Organization Name:UNITY FAMILY HEALTHCARE
Other - Org Name:ST OTTOS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOUAKOSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-632-1219
Mailing Address - Street 1:920 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3540
Mailing Address - Country:US
Mailing Address - Phone:320-632-9281
Mailing Address - Fax:320-632-1376
Practice Address - Street 1:920 4TH ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3540
Practice Address - Country:US
Practice Address - Phone:320-632-9281
Practice Address - Fax:320-632-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN326702311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
7111819OtherMEDICA
3Y330TOtherBCBS
MN245257Medicare ID - Type Unspecified